Quick Reference for Medical Billing and Coding

When it comes to having a wealth of jargon, the medical billing and coding industry could publish its own dictionary. However, the quick recognition and understanding of these terms can play a crucial role in continued success for healthcare accountants by minimizing confusion and maximizing clarity. Holbrook & Manter’s Business Service & Solutions Team works to provide you with a basic understanding of this field so you can flawlessly move forward toward an optimal financial future.

Below, we take aim at the basic semantics regarding coding and compliance for medical providers in the United States.

Top 25 Most Common Medical Coding Acronyms

Guide to Medical Billing and Coding TermsWhile filing and billing for a medical practice, you will undoubtedly come across a slew of abbreviations. While memorizing all of the terms may be challenging, we have pinpointed some of the most commonly used acronyms and provided a basic definition to act as a quick reference along your way.

ATDApplied to Deductible

The funds owed to the provider, as determined and fixed by the agreed insurance policy.

AOBAssignment of Benefits

Funds paid directly to the medical provider.

BCBSBlue Cross Blue Shield

A group of affiliated medical insurance providers, separate from associations.

COBCoordination of Benefits

Essentially which insurance agency is the primary provider and which is the secondary when a patient has more than one policy.

DOSDate of Service

When the service took place.

DCIDuplicate Coverage Inquiry

When an insurance provider contacts another to see if they’re currently providing specific coverage.

EDI – Electronic Data Interchange

The electronic network that collects information before delving it out to particular individual insurance providers.

EFTElectronic Funds Transfer

Transferring money electronically. A credit or debit charge or transfer must take place.

EMR – Electronic Medical Records

Digitally formatted health records; the complete record of a patient that is sent to a healthcare provider and/or insurance agency.

EOB – Explanation of Benefits

An explanation of what the insurance company provides, usually consisting of covered charges, payment methods, deductibles, patient responsibility and potential write-offs.

FDCPAFair Debt Collection Practices Act

Law explaining the guidelines for creditors and collections agencies trying to collect from delinquent accounts.

FI Fiscal Intermediary

The Medicare official that handles Medicare claims and cases.

HIPAAHealth Insurance Portability & Accountability Act

The “privacy” rule of the health industry that outlines the use and or distribution of personal health information for specific organizations.

HMO – Health Maintenance Organization

A healthcare policy that requires a gatekeeper or primary care physician. If a situation calls for further action, this gatekeeper will refer the patient to a different specialist.

INN – In-Network

A medical care provider that is contracted with the specific insurance provider used by a patient.

IPAIndependent Practice Association

The group of medical care providers contracted with an HMO plan.

N/CNon-Covered Charge

A healthcare service that is not covered by the insurance policy.

NEC – Not Elsewhere Classifiable

The abbreviation used on ICD forms when the information given does not permit a more refined assignment.

OON – Out of Network

A medical service provider that does not currently work with the specific insurance agency.

PPOPreferred Provider Organization

A network of medical care providers that patients are allowed to visit, as determined by the insurance agency.

PHIProtected Health Information

Basic patient information that remains classified, usually consists of name, date of birth, social security number, insurance ID, medical records and telephone numbers.

TINTax Identification Number

The specific number assigned to an individual for tax filing and tracking purposes.

TOP Triple Option Plan

The cafeteria-style insurance plan that offers a choice of HMP, PPO or traditional insurance policies.

UCRUsual Customary & Reasonable

The coverage limitations set in place by an insurance patient. Limits the maximum amount of funding a company will pay for a service.

WC – Workers’ Compensation

Work-related injury insurance claim.


For a comprehensive list of acronyms and terms, visit www.CMS.gov.

For more information regarding billing and coding or to speak with BSST today, contact us and we will help you move forward!