Glossary Main > Medical Insurance glossary
Medical Insurance Terms
Copay
The amount an insured person is expected to pay for a medical expense at the time of the visit.
Health Care Clearinghouse
Under HIPAA, an entity that processes or facilitates the processing of information received from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction, or one that receives a standard transaction from another entity and processes or facilitates the processing of that information into nonstandard format or nonstandard data content for a receiving entity.
Medical Coder
Medical coders are responsible for assigning codes to diagnoses and procedures in order to insure proper financial reimbursement from insurance companies and government agencies. Medical coders, also called insurance coders or claims specialists, use a universally recognized coding system and must insure correct code selection for compliance with federal regulations and insurance requirements. The information compiled by the medical coders is used to prepare statistical reports for private clinic use and public health reasons
The American Academy of Professional Coders (AAPC).Coders who pass the national exam become
Certified Coding Specialists (CCS), Certified Coding Specialist-Physician (CCS-P), entry-level certification through its Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H).
ICD-9
International Classification of Diseases, Ninth Revision; this is a system of classifying diseases using specific diagnoses code numbers to describe a patient
CPT
Current Procedural Terminology CPT Codes are five-digit numbers used to represent the universe of medical and psychiatric services given to patients. They are revised each year to reflect advances in medical technology. The 2002 revision contained 8,107 codes and descriptors. VA uses CPT codes to identify ambulatory care procedures only; ICD-9 codes are used for inpatient procedures.
Electronic Media Claim (EMC)
This term usually refers to a flat file format used to transmit or transport claims, such as the 192-byte UB-92 Institutional EMC format and the 320-byte Professional EMC NSF.
