USA Healthcare/Medical Billing abbreviations Part-2

The previous chapter we learn about abbreviations from A to D, in this chapter, we continue the abbreviation part from E to M…



Electronic Claim:  When a claim sent electronically to an insurance carrier from a provider’s billing software. This format of claim is called electronic claim.

Electronic Funds Transfer(ETF): A method of transferring money electronically from a patient’s bank account to a provider or an insurance carrier or Insurance company account to providers account is called ETF.

Evaluation and Management (E/M): E/M refers to the section of CPT codes most used by healthcare personnel to describe a patient’s medical needs.E/M CPT codes start from 99201 to 99499.

Electronic Medical Records (EMR): EMR is a digitized medical record for a patient managed by a provider onsite.

Enrollee: A person enrolled in health insurance plan and covered by a health insurance plan is called enrollee.

Explanation of Benefits (EOB): A document attached to a processed medical claim wherein the insurance company explains the services they will be paid or denied is called EOB.

Electronic Remittance Advice (ERA): The digital version of EOB, which specifies the details of payments made on a claim either by an insurance company or required by the patient.

ERISA: Stands for the Employee Retirement Income Security Act of 1974. This act established guidelines and requirements for health and life insurance policies including appeals and disclosure of grievances.


Fee for Service: This refers to a kind of medical coverage wherein the supplier is paid for each administration they perform. Individuals with charge for-benefit designs commonly can pick whatever doctor’s facilities and doctors they need to get watch over higher deductibles and co-pays.

Fee Schedule: A document that outlines the costs associated with each medical service provided by the provider.


Healthcare Financing Administration(HCFA):  The form used to submit the paper claim is called HCFA form or CMS-1500 form.

Healthcare Financing Administration Common Procedure Coding System (HCPCS): HCPCS is a three-tier coding system used to explain services, devices, and diagnoses administered in the healthcare system.

Healthcare Insurance: This is insurance offered to a group or an individual to cover costs associated with medical care and treatment. Those covered by healthcare insurance typically must pay a premium for getting coverage for treatment.

Healthcare Provider: These are the entities that offer healthcare services to patients, including hospitals, physicians, and private clinics, hospices, nursing homes, and other healthcare facilities.

Healthcare Reform Act: The major healthcare legislation passed in 2010 designed to make healthcare accessible and less expensive for more Americans.

Health Insurance Portability and Accountability Act (HIPAA): HIPAA was a law passed in 1996 with an aim to improve the scope of healthcare services and establish regulations for securing healthcare records from fraud waste and abuse.

Health Maintenance Organization (HMO): A sort of medical coverage arrange for that normally confines scope to mind from specialists who work for or contract with the HMO. It for the most part won’t cover out-of-organize mind aside from in a crisis. A HMO may expect you to live or work in its administration zone to be qualified for coverage.HMOs are systems of medicinal services suppliers that offer social insurance intends to individuals for restorative administrations solely in their system.

Hospice: This refers to medical care and treatment for persons who are terminally ill.


ICD-9 Codes: ICD-9 codes are an international set of codes that represent diagnoses of patients’ medical conditions as determined by physicians.

ICD-10 Codes: ICD-10 codes are the updated international set of codes based on the preceding ICD-9 codes. ICD-10 codes are estimated to be mandatory in the American healthcare system by October 2014.Started from 10-01-2015.

Indemnity: Indemnity plans allow you to direct your own healthcare and visit almost any doctor or hospital you like. The insurance company then pays a set portion of your total charges. Indemnity plans are also referred to as “fee-for-service” plans.

In-Network: This term refers to a provider’s relationship with a health insurance company. A group of providers may contract with an insurance company to form a network of healthcare professionals that a person can choose from when enrolled in that insurance company’s health plan.

Inpatient: Inpatient care occurs when a person has a stay at a healthcare facility for more than 24 hours or a patient overnight stay in hospital is count as an in-patient.

Independent Practice Association (IPA): The IPA is a professional organization of physicians who have a contract with an HMO.

Intensive Care: Intensive care is the unit of a hospital reserved for patients that need immediate treatment and close monitoring by healthcare professionals for serious illnesses, conditions, and injuries.


Medicare Administrative Contractor (MAC): MACs are contracted with the federal government to process Medicare claims. MAC is a private healthcare insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.

Managed Care Plan: A health insurance plan in which patient only receive coverage if they see providers who operate in the insurance company’s in-network.

Maximum Out of Pocket: The amount a patient is required to pay. After a patient reaches their maximum out of pocket, their healthcare costs should be covered by their plan.

Medical Assistant: An employee in the healthcare system such as a physician’s assistant or a nurse practitioner who perform duties in administration, nursing, and other ancillary care.

Medical Coder: A medical coder is responsible for assigning various medical codes to services and healthcare plans described by a physician on a patient’s superbill.

Medical Billing Specialist: A medical billing specialist is a person who is working on behalf of provider or hospitals using information regarding services and treatments performed by a provider to complete a claim for filing with an insurance company so the provider can be paid.

Medical Necessity: This term refers to health care services or treatments that are medically necessary for the patient as per requirement. This does not include cosmetic or investigative services.

Medical Record Number: A one of a kind number credited to a man’s therapeutic record so it can be separated from other medicinal records. It is just a single for one patient in one healing center.

Medicare Secondary Payer: The insurance agency that covers any residual costs after Medicare has paid for a patient’s scope.

Medical Savings Account (MSA): An MSA is an optional health insurance payments plan whereby a person apportions part of their untaxed earnings to an account reserved for healthcare expenses. A man with a MSA can just contribute a specific measure of their income every year. Any unused subsidizes in a MSA toward the finish of the year will move over to the following.

Medical Transcription: The process of converting dictated or handwritten instructions, observations, and documentation into digital text formats.

Medicare: Medicare is a government insurance program started in 1965 to provide healthcare coverage for persons over 65 and eligible people with disabilities.

Medicare Coinsurance Days: From 61st through 90th days of inpatient treatment, as per the law, patients has to pay for a part of their human services Medicare coinsurance days.

Medicare Donut Hole: This term refers to the discrepancy between the limits of healthcare insurance coverage and the Medicare Part D coverage limits for prescription drugs.  

Medicaid: Medicaid is a joint federal and state assistance program started in 1965 to provide health insurance to lower-income persons. Both state and federal governments fund Medicaid programs, but each state is responsible for running its own version of Medicaid within the minimum requirements established by federal law.

Medigap: Medigap is supplemental medical coverage under Medicaid for qualified people who require help covering co-pays, deductibles, and other huge charges.

Modifier: Modifiers are additions to CPT codes that explain alterations and modifications to an otherwise routine treatment, exam, or service.

to be continued………..


Stay with us, keep learning

Best Wishes

All Pictures source-Google

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