Medical billing Terms

Incremental Nursing Charge​ - Charges for hospital nursing services in addition to basic room and board. 

Indemnity​ - Also referred to as fee-for-service. This is a type of commercial insurance were the patient can use any provider or hospital.

 In-Network (or Participating)​ Provider ​- An insurance plan in which a provider signs a contract to participate in. The provider agrees to accept a discounted rate for procedures. 

Inpatient​ - Hospital stay of more than one day (24 hours). IPA​ - Independent Practice Association. An organization of physicians that are contracted with a HMO plan. 

Intensive Care​ - Hospital care unit providing care for patients who need more than the typical general medical or surgical area of the hospital can provide. May be extremely ill or seriously injured and require closer observation and/or frequent medical attention. 

MAC​ - Medicare Administrative Contractor. Contractors who process Medicare claims. 

Managed Care Plan​ - Insurance plan requiring patient to see doctors and hospitals that are contracted with the managed care insurance company. Medical emergencies or urgent care are exceptions when out of the managed care plan service area. 

Maximum Out of Pocket​ - The maximum amount the insured is responsible for paying for eligible health plan expenses. When this maximum limit is reached, the insurance typically then pays 100% of eligible expenses.

Medical Assistant​ - A health care worker who performs administrative and clinical duties in support of a licensed health care provider such as a physician, physician's assistant, nurse, nurse practitioner, etc. 

Medical Coder​ - Analyzes patient charts and assigns the appropriate code. These codes are derived from ICD-9 codes (soon to be ICD-10) and corresponding CPT treatment codes and any related CPT modifiers. 

Medical Billing Specialist​ - Processes insurance claims for payment of services performed by a physician or other health care provider. Ensures patient medical billing codes, diagnosis, and insurance information are entered correctly and submitted to insurance payer. The specialist enters insurance payment information and processes patient statements and payments. Performs tasks vital to the financial operation of a practice. Knowledgeable in medical billing terminology.

Medical Necessity​ - Medical service or procedure that is performed on for treatment of an illness or injury that is not considered investigational, cosmetic, or experimental. 

Medical Record Number​ - A unique number assigned by the provider or health care facility to identify the patient medical record. 

MSP​ - Medicare Secondary Payer. 

Medical Savings Account​ - Tax exempt account for paying medical expenses administered by a third party to reimburse a patient for eligible health care expenses. Typically provided by employer where the employee contributes regularly to the account before taxes and submits claims or receipts for reimbursement. Sometimes also referred to in medical billing terminology as a Medical Spending Account. 

Medical Transcription​ - The conversion of voice recorded or hand written medical information dictated by health care professionals (such as physicians) into text format records. These records can be either electronic or paper. 

Medicare​ - Insurance provided by federal government for people over 65 or people under 65 with certain restrictions. There are 2 parts: 

● Medicare Part A​ - Hospital coverage 

● Medicare Part B​ - Physicians visits and outpatient procedures 

● Medicare Part D​ - Medicare insurance for prescription drug costs for anyone enrolled in Medicare Part A or B. 

Medicare Coinsurance Days​ - Medical billing terminology for inpatient hospital coverage from day 61 to day 90 of a continuous hospitalization. The patient is responsible for paying for part of the costs during those days. After the 90th day, the patient enters "Lifetime Reserve Days."

Medicare Donut Hole​ - The gap or difference between the initial limits of insurance and the catastrophic Medicare Part D coverage limits for prescription drugs. 

Medicaid​ - Insurance coverage for low income patients. Funded by Federal and state government and administered by states.