Accounts Receivable Management Software - Application software that records and processes accounts receivable information, and turns it into automated workflow steps for the purpose of reducing A/R days. Click Here for more information on ARI (Accounts Receivable Interactive) from PracticeAdmin.

Ambulatory Surgery Center - Often used synonymously with “outpatient surgery center,” or “same day surgery center,” an ASC is a health care facility that provides surgical procedures similar to a specialty hospital, but in an outpatient setting which doesn’t typically provide emergency services or overnight stays. Visit the Ambulatory Surgery Center Association for more information.

Ancillary Providers - Providers in fields such as radiology, home health, laboratory, skilled nursing, physical therapy and rehabilitation, dialysis, and ambulatory surgery who provide services over top of, and supporting those provided by the physicians.
Note: PracticeAdmin makes it easy to attach referring providers when creating claims.

Anesthesia Billing - The subset of medical claims billing that has to do specifically with billing for anesthesia services. Data which isn’t required on other medical claims, such as units and time, is necessary to bill correctly for anesthesia services. Many billing companies and medical billing software systems don’t do anesthesia billing.
Note: PA makes it easy to do anesthesia billing.

Authorization (Preauthorization) - Often used synonymously with “precertification,” preauthorization is the process of receiving authorization for a provider’s proposed treatment plan from the proper third-party payor prior to providing treatment.
Note: PA automatically tracks preauthorizations and precertifications for you.

Billing Software - Software that allows for the creation of medical claims on the proper insurance claim form to be submitted to payors. Today, most medical billing software systems also allow for the electronic submission of medical claims to third-party payors. Medical billing software can be generally divided into two types: web-based software, and traditional client-hosted software.

Chiropractor Billing - The subset of medical claims billing that has to do specifically with billing for chiropractic services. To learn more about the rules and regulations specific to chiropractic billing, click here

Claim - A medical claim is a request to a third-party payor for reimbursement for professional medical services provided to a patient. Part A claims are filed on UB 04 Forms and Part B claims are filed on HCFA 1500 or CMS 1500 Forms.

Claims-Scrubbers - Software which is designed to “scrub” medical claims and make them “clean” prior to their submission to payors by ridding them of omissions, or errors which may result in the claim being denied outright, or reimbursement being delayed. The best way for determining the effectiveness of a medical billing software system’s claims-scrubber is to measure the average clean-claims rate. Click here to learn more about PA’s higher than 95% clean claims submission rate.

Clean-Claims Rate - The clean-claims rate is the percentage of medical claims which are accepted by the payor the first time they are sent. A medical practice’s clean-claims rate is one of the best predictors of its reimbursement levels and A/R days.

Co-insurance - A term which refers to the splitting of insurance, or spreading of risk between the insurance carrier and the insured party. Typically, the percentage of a medical bill that a patient will be responsible for after their deductible has been met, and up to the policy’s stop loss, is referred to as the coinsurance.

Co-payment - Often called copay for short, it is a fixed amount of money, defined in a health insurance policy, that the patient must pay for medical services. Copayments do not typically apply towards a patient’s out-of-pocket maximum, and insurance companies often won’t extend any benefits until the copayment has been paid.

CPT - The commonly used anachronym for the Current Procedural Terminology code set, which is a copyrighted system for sharing standardized information regarding medical procedures between providers, coders, patients, payors, and accreditation organizations, that is maintained by the American Medical Association.
Note: PA automatically maintains an up-to-date list of all CPT codes, which you can easily search to find the right code for your claim.

Deductible - Most health insurance plans have a deductible, which is an amount of money defined in the policy that the patient is responsible to pay prior to receiving any benefits from the insurance carrier.

Document Management Software - A software system designed to allow for the storing, searching, and editing of electronic documents and/or digital copies of paper documents. Document management software is an integral part of enterprise content management, workflow, document imaging, or records management systems. Click here to learn more about PracticeAdmin’s web-based digital document management system- GPS- which uses OCR technology to make it easy to store and search for things like EOBs, and paper checks.

Electronic Data Interchange (EDI) - Generally refers to the transfer of information used for business transactions between computers at different companies using a standardized format, and in medical billing specifically refers to the process of electronically submitting claims to payors, as well as electronic eligibility and preauthorization requests.
Note: PA’s software-as-a-service pricing includes EDI services at no extra cost.

Electronic Health Record (EHR)/Electronic Medical Record (EMR) - A digital version of a normal patient medical record that providers store and access via computer rather than papers and manila folders. In recent years, CMS has offered varying incentives to encourage medical providers to begin using electronic medical record systems but adoption has been slow due to high costs and the disruption implementing an EMR can cause to a medical practice. Note: PA Clinical Manager (PCM), PA’s web-delivered EMR is customized to match practice’s current workflow as closely as possible prior to implementation so as to cause as little a disruption as possible. Click to learn more

Electronic Remittance Advice (ERA) - Used in the vernacular as an electronic representation of a paper EOB, ERAs can be any number of formats payors use to electronically communicate claims payment information to medical providers.
Note: PracticeAdmin provides ERAs and ERA auto-posting features at no extra charge.

Eligibility - Refers to the practice of verifying a patient’s insurance benefits information prior to treatment. Similar to preauthorization, but differs in that preauthorization is sought prior to enacting the provider’s post examination treatment plan, and a patient’s eligibility is determined prior to ever seeing the provider.
Note: PracticeAdmin’s eligibility module automatically verifies insurance eligibility based on the information you put in the scheduler. How many claims do you have denied every month because the patient wasn’t eligible?

Fee Schedule - Most often used in reference to the Medicare Physician Fee Schedule (MPFS), a fee schedule can be any list of professional services and the rates at which they are reimbursed by the payor. Physicians often use the MPFS as a guideline for the prices they charge patients. Access the MPFS search tool at http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp?agree=yes&next=Accept.
Note: PA makes it easy for medical practices to set their fee schedule as a multiple of Medicare’s maximum allowed, or to load up multiple specific fee schedules for different

HCFA 1500 Form/ CMS 1500 Form - The standard form for submitting Medicare Part B health insurance claims.

Health Insurance Portability and Accountability Act (HIPAA) - Passed in 1996, HIPAA was designed to ensure a covered persons continuous access to healthcare benefits when making employment changes. HIPAA also addressed privacy and security standards for dealing with protected health information (PHI), as well as standardizing codes sets for EDI transactions in an effort to simplify administrative tasks and promote e-commerce in the healthcare arena.
Note: PracticeAdmin software is HIPAA compliant.

Health Level 7 (HL7) - Accredited in 1994 by the American National Standards Institute (ANSI), HL7, Inc. is a not-for-profit, volunteer organization that develops standard protocols for the cross-platform transfer of electronic information between healthcare organizations. The term HL7 is more often used to refer to the standard itself, rather than the organization (i.e. Do you have HL7 interface capabilities?).

ICD-9 - Often referred to as the International Classification of Diseases, or ICD, the International Statistical Classification of Diseases and Related Health Problems is a standard list of codes originally developed by the World Health Organization (WHO) as a way of categorizing similar diseases and diagnoses for promoting international comparability of statistics like morbidity and mortality. For medical billing purposes in the United States, it is necessary to assign a diagnoses, or ICD code, and procedural, or CPT code to each claim. Medical billers currently use the 9th revision of the ICD, or ICD-9 codes in the United States, and CMS has announced that it will begin using ICD-10 on October 1, 2013.

ICD-10 - see ICD-9

Medical Claim - A medical claim is a request to a third-party payor for reimbursement for professional medical services provided to a patient. Part A claims are filed on UB 04 Forms and Part B claims are filed on HCFA 1500 or CMS 1500 Forms.

Medical Coding - The process of assigning the correct diagnoses and procedure codes to a medical claim according to the information contained on the encounter form and the physician’s clinical notes.
Note: PracticeAdmin’s PCM software suggests codes for you depending on the information you put into your note, and will tell you when your documentation doesn’t support a certain code.

Medicare Part A Billing - The subset of billing medical claims to Medicare that has to do with hospital-based, or inpatient services.
Note: PA allows for some Part A billing, click to learn more.

Medicare Part B Billing - The subset of billing medical claims to Medicare that has to do with professional services, or outpatient services.
Note: PracticeAdmin’s Enterprise Suite allows for the efficient billing of all types of Medicare Part B claims.

Medical Record (Patient Record) - A medical or patient record contains all the information that describe’s a patient’s current and historic health. Some examples of things that may be included in a medical record are: lab test results, prescriptions, clinical notes, past family social history, etc.
Note: PracticeAdmin offers software for people who just want to get rid of all their old paper records and stop paying for storage, as well as those who are looking to start using electronic medical records.

Medical Transcription - The process of listening to a medical provider’s recorded voice describing a patient encounter, and typing the provider’s words into a word processor to create a clinical note.
Note: Eliminating the typical $40k salary of a medical transcriptionist will more than cover the cost for a single provider practice to implement the entire PA Clinical Manager EMR solution- and it can automatically turn a voice recording into text in a clinical note! Click here to learn more.

Outpatient - Medical treatments which are completed within the course of a day and do not require the patient to stay overnight in a hospital or other treatment facility are known as outpatient services.

Outsource Billing- Term which refers to the process of contracting with a third-party medical billing service to provide the infrastructure, knowledge, and employee labor necessary to conduct all of a medical practice’s claims billing needs.
Note: If you are looking for a billing service, PA’s Recommended Billing Services are a good place to start.

Patient Balance - The amount of money that a patient owes on a particular medical claim.

Practice Management - Refers to the process of managing a medical practice, and can include such diverse tasks as real estate allocation, staffing, supply-chain management, medical billing management, appointment scheduling, etc.

Pre-Certification - see Preauthorization

Primary Insurance - In cases where more than one insurance policy is simultaneously providing coverage for an individual insured, the primary insurance is the insurer which must first pay out the benefits of their policy, prior to the claim being submitted to the other insurers.

Referring Physician - When one medical provider requests an appointment for a patient with another medical provider, the first provider is considered the Referring Physician on any medical claims generated by the second provider for services rendered to that patient.
Note: PA keeps an up-to-date, searchable, database of physician NPI#s- making it easy to attach Referring Physicians to claims.

Revenue Cycle Management - A term which refers to any number of practices and processes designed to aid in the management, and usually optimization, of a business’ revenue cycle. It can be used as an adjective to describe things as varying as companies, software, and personnel.

Rural Health Center - More commonly known as RHCs, the term can be used to refer to any healthcare facility which has been designated by the federal government to be in compliance with the Rural Health Clinics Act.
Note: PracticeAdmin software allows for billing RHCs.

Secondary Insurance - In cases where more than one insurance policy is simultaneously providing coverage for an individual insured, the secondary insurance is responsible for payment only after the primary insurer has paid out the full benefits of the primary policy.

Scheduling Software - Any software application which allows medical providers to schedule appointments for patients may be commonly referred to as scheduling software.
Note: PA’s powerful rules-based scheduler allows you to create appointment type and length templates for multiple providers utilizing multiple treatment settings.

Software-as-a-Service (SAAS) - A method of deploying software whereby the software provider sells a recurring license to the customer, and then as a service provides on-demand access to that software.
Note: Because PracticeAdmin uses the SAAS model, our low monthly subscription fees are inclusive of training, support, software upgrades, and more.

Third-Party Billing Service - A company which handles outsourced medical billing.

Traditional/Client-Hosted/Legacy Software - Different terms which are used generally to refer to software which is hosted locally, on the customer’s machines, rather than web-based and provided as software-as-a-service.
Note: Microsoft has estimated that the upfront license fee of traditional software systems accounts for a mere 5% of the total life cycle cost of the software.

UB-04 Form - The standard medical claims billing form used for creating and submitting Medicare Part A claims.

Web-Based Software - See SAAS

Worker’s Compensation - A type of insurance which insures employees against medical claims arising out of any incident that occurs as a direct result of their employment. Worker’s compensation insurance is paid for by the employer, and the benefits are payable to the employee if and only if they give up their right to sue the employer.
Note: PracticeAdmin software makes it easy to bill both health insurance and worker’s comp insurance.

Workflow Management Software - Any software which is designed to streamline and automate a current workflow process.
Note: ARI from PracticeAdmin automatically matches billing related workflow with the right employee depending on skill level.