Medical Billing Glossary

Here are a few common medical billing terms for those who aren’t familiar with the terms used in the medical billing industry.

Medical Billing or Physician Billing

The process that converts documentation of a physician visit (“encounter”) into a “claim”, filing it with a “payer” or “payor” (insurance company or carrier), posting payments, following-up on any “denial”, billing the patient for any remaining balance, and managing the “accounts receivable”. For more information see medical billing. Note: billing for hospital (in-patient) services may also be referred to as “medical billing” though the skills and technology required differ significantly between hospital billing (“technical” or “in-patient”) and physician billing (“professional”).

Medical Billing Company

A company that performs the medical billing process for one or more physician groups. Many billing companies concentrate on selected physician specialties. For more information see medical billing companies.

Medical Billing Services

The array of functions performed by a medical billing company, including charge entry, electronic claims filing, payment posting, denial management, A/R management and patient billing. For more information see medical billing services.

Medical Coding, Coding Services

The process of assigning the correct “codes”, usually CPT (“procedure codes”) and ICD (“diagnosis codes”), to a specific encounter. In many cases, the coding is performed by the physician when they sign off on a case (i.e. sign off on the documentation). In other cases, a coder performs the task. It is recommended that coders be certified by the American Academy of Professional Coders. In either case, the coding is based on, and must correspond with the physicians documentation (the “medical record”). A common truism for billing: “If it isn’t documented, it didn’t happen.”

Medical Billing Software

The software used by medical billers. Billers can bill for one group as part of the group’s staff or for many groups as part of a medical billing company. In addition to supporting all of the medical billing functions, the software may provide scheduling, check-in and other “front office” functions associated with office-based physician groups. For more information see medical billing software.

Practice Management Software

Another term for medical billing software. The terms are used more or less interchangeably. For more information see practice management software.

Practice Management Services

Another term sometimes used for medical billing services, though the term is more often used to describe medical billing services plus other important back office functions such as practice payroll, accounts payable, etc. For more information, see practice management services.

Revenue Cycle Management

Another term for medical billing, usually used when a medical billing company is performing the billing function. Initially used to refer to hospital billing, but the term is now frequently used for physician billing as well.