medical glossary terminology

Glossary of Medical Terms

This glossary highlights terminology not discussed more thoroughly on another page:

837 - term used to describe the code set for submitting medical claims electronically

APC - Ambulatory Payment Classification, a fee schedule for payment of hospital outpatient services

AR - Accounts Receivables, a term used to indicate outstanding dollars and accounts that the hospital or physician are still hoping to get paid for.

Arbitration - Arbitration is the process of dispute resolution where two opposing parties go before a judge to try to solve disputes. As it pertains to medical issues, compensation arbitration can be between the patient and either the insurance company or the employer who disputes the injury.

ASC - Ambulatory Surgery Center, a description of a standalone surgery facility as opposed to one being located within a hospital setting

Billing - Also known as patient accounting or patient financial services, this is the department responsible for sending out and trying to collect on medical bills from insurance companies within hospitals or other healthcare facilities

Compliance - a term that came into vogue in 1997, as it applies to hospitals it's the process of setting up a way for hospitals and other medical facilities to monitor themselves to protect themselves against accusations of fraudulent or illegal activities

Denials - a term used to describe any error that denies payment of an insurance claim after it's been sent to an insurance company

Durable Medical Equipment - more commonly known as DME, this is mainly considered as supplies that a patient can use at home as opposed to only being used within a medical facility. Many insurance companies will not cover this if given within a hospital setting, but some will cover a portion if a patient has to purchase them from a DME marketer

DRG - Diagnosis Related Groups, a term used to describe how inpatient claims are paid, based on a formula determined by both diagnosis and procedure codes

E&M Codes - this term stands for "evaluation and management", and is used to indicate what type of visit a patient is seeing a physician for, and for how long. It's also used in emergency room settings, as well as to indicate observation status. All medical practitioners use these codes.

ESA - Erythropoiesis Stimulating Agents, pharmaceuticals that stimulate red blood cell production

ESRD - End Stage Renal Disease, otherwise known as chronic kidney disease

FI - Fiscal Intermediary, a term used to describe the regional Medicare carrier for a healthcare provider. The FI may or may not be in the same state as the provider.

FQHC - Federally Qualified Health Center. These are providers of medical services in urban and rural communities for those who may not have the means to receive health care in other ways. They offer a variety of medical services, sometimes including dental and psychiatric services.

HMO - Health Maintenance Organization, a type of insurance carrier whose focus is on prevention of medical illnesses upfront. Also known as managed care.

MEA - Microwave Endometrial Ablation, a minimally invasive procedure for women with heavy uterine bleeding problems

Medical Records - the deparment in a medical facility responsible for the coding and storing of confidential medical records.

Occurrence Codes - codes that help define a specific event that may affect how a medical claim is processed by an insurance company. They are broken down into accident codes, medical condition codes, insurance related codes and service related codes.

Pricing Transparency - This is a term used when talking about hospitals that are putting their charges online for the public to see. As of early 2008, 32 states have passed laws making this a mandatory requirement.

Referrals - also known as scripts, this is the signed piece of paper a patient takes to another provider of services such as lab, radiology, other physicians, or any other health care provider the primary physician wishes a patient to see.

Revenue Codes - Revenue codes are 3 digit codes that denote where and what types of services are being performed in a hospital setting. These codes will go on hospital bills, and are not used by physicians.

SNF - Skilled Nursing Facility, but also sometimes used as a description for a nursing home. Unlike a nursing home, it provides skilled rehabilitation services which may, over time, allow the patient to be able to go back home, and thus is a temporary arrangement. A person must have first been an inpatient for at least 3 days and then have a physician order the admission to have rehabilitation services at least 5 days a week.

Value Codes - special billing codes that help identify data and financial elements about other insurances to the insurance company being billed. Most crucial for Medicare billing.

WPS - WPS Medicare, the fiscal intermediary covering a number of states in the Midwest.