Medical Billing and Coding Specialist Terms & Vocabulary

Accounts receivable (A/R)

Money owed to the provider that has not yet been collected.

Clearinghouse

A company that checks and forwards electronic claims to insurers.

CMS-1500

The standard claim form for professional (physician) services.

CPT

Current Procedural Terminology, five-digit codes for medical services and procedures, maintained by the AMA.

Denial

A payer’s refusal to pay a claim, which may be corrected and resubmitted or appealed.

E/M coding

Evaluation and management codes for office visits and other patient encounters.

EOB / ERA

Explanation of benefits / electronic remittance advice: the payer’s explanation of what was paid and why.

HCPCS Level II

Codes for supplies, equipment, drugs and services not in CPT, such as ambulance services.

ICD-10-CM

The diagnosis coding system used in the U.S. for all healthcare settings.

Medical necessity

Whether a service is reasonable and necessary for the patient’s diagnosis.

Modifier

A two-character code added to a CPT or HCPCS code to give more information, such as -25 or -59.

NCCI edits

National Correct Coding Initiative rules that prevent improper code combinations.

Provider query

A compliant question to a provider to clarify documentation.

Revenue cycle

The full process from patient registration to final payment.

UB-04

The standard claim form for institutional (facility) services.

Practice these terms

Test yourself with the free Medical Billing and Coding Specialist practice test: it includes vocabulary questions built from this list. For a complete course, see Medical Billing and Coding Specialist training.

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