Color coded files

Medical Billing and Coding: 13 Terms to Know

Medical billing and coding specialists have to know many healthcare terms in order to do their jobs efficiently and quickly. The healthcare system can be confusing because of the complex terms that change all the time. Here are just some of the many healthcare terms that an aspiring medical billing and coding specialist should know.

  1. Beneficiary
    A beneficiary is someone who gains an advantage from something. In the case of healthcare, the beneficiary is the person covered under the healthcare plan like the primary beneficiary or a family member covered under a group health insurance plan.
  2. Collection Ratio
    The collection ratio refers to the difference between the amount a healthcare provider charges the patient and the amount the healthcare provider actually receives. It refers to the uncollected amount of costs for providing healthcare.
  3. Co-pay
    Insurance providers often require the beneficiary of an insurance plan to pay for part of a healthcare cost. The co-pay refers to the amount a beneficiary has to pay in conjunction with the insurance carrier who typically pays for the rest of the costs.
  4. Deductible
    Insurance companies often require that patients pay a certain amount of money to the insurance carrier before the insurance actually kicks in for healthcare. This is called the deductible.
  5. Group Name
    The group name is found on your insurance card and refers to the type of insurance plan by which you are covered.
  6. Group Number
    The insurance company will assign each group beneficiary a number. This is the group number, and it can be found on your individual insurance card.  If a family is on one insurance plan through an employer, the group number is typically the same number for all family members.
  7. Healthcare Provider
    The healthcare provider is simply the medical practice or hospital that provides the healthcare to the patient.
  8. Inpatient
    When a patient stays at a hospital overnight for treatment or surgery, it’s referred to as “inpatient” care.
  9. Outpatient
    Outpatient care is treatment or surgery that is received outside of a hospital.
  10. PPO
    PPO stands for a Preferred Provider Organization. These organizations are networks of healthcare providers that agree to provide healthcare at reduced rate for specific insurer’s clients.
  11. Premium
    The amount a beneficiary pays for their health coverage each month.
  12. Medicaid
    Medicaid is a federal program that provides health insurance to low income families.
  13. Medicare
    Medicare is a federal program that provides health insurance to people age 65 and older and to younger people with certain disabilities.
Last Updated: April 15, 2015