Medical Billing Wiki
Welcome to the Medical Billing and Medical Coding Dictionary / Encyclopedia
The medical billing wiki is a member edited encyclopedia and dictionary for all things related to the medical billing and coding industry. The purpose of this medical billing dictionary is to help define, explain and assist in learning the many aspects of the medical billing and coding industry. The medical billing dictionary is an ongoing, collaborative effort by billing and coding industry specialists to provide as much information about the various subjects as possible.
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Defining the Medical Billing Industry
What is medical billing? Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government sponsored programs. Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS Exam, RHIA Exam and others. Certification schools are intended to provide a theoretical grounding for students entering the medical billing field.
The medical billing process is an interaction between a health care provider and the insurance company (payer). The entirety of this interaction is known as the billing cycle sometimes referred to as Revenue Cycle Management. This can take anywhere from several days to several months to complete, and require several interactions before a resolution is reached. The relationship between a health care provider and insurance company is that of a vendor to a subcontractor. Health care providers are contracted (credentialed) with insurance companies to provide health care services. The interaction begins with the office visit: a physician or their staff will typically create or update the patient's medical record... Read more on: Medical Billing
What is Medical Coding?
Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers. The diagnoses and procedures are usually taken from a variety of sources within the health care record, such as the transcription of the physician's notes, laboratory results, radiologic results, and other sources.
Diagnosis codes are used to track diseases and other health conditions, inclusive of chronic diseases such as diabetes mellitus and heart disease, and contagious diseases such as norovirus, the flu, and athlete's foot. These diagnosis and procedure codes are used by government health programs, private health insurance companies, workers' compensation carriers and others... Read more on: Medical Coding
What is ICD-10?
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. The codes can be expanded to over 16,000 codes by using optional sub-classifications. The detail reported by ICD can be further increased, with a simplified multi-axial approach, by using codes meant to be reported in a separate data field. The WHO provides detailed information about ICD online, and makes available a set of materials online, such as an ICD-10 online browser, ICD-10 Training, ICD-10 online training, ICD-10 online training support, and study guide materials for download... Read more on: ICD-10
How to Add to the Medical Billing Wiki:
This wiki allows registered members to add or edit entries that pertain to the medical billing and coding industry as a whole. Any entries added that are considered spam or do not pertain to medical billing and/or medical coding in some manner, will be removed by admin. Wiki Questions or Need Help: Ask an Administrator
1. Login - or - Create an Account to add and/or edit dictionary entries. Only registered members are allowed to add or edit wiki entries.
2. Read Create Your First Article if this is the first time you are adding to the medical billing wiki.
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