When doing medical billing it is critical to know the terms for several reasons. The most important reason is making sure that all of the diagnosis codes and the procedure codes are done properly. Without these codes being on the claim the company will not get paid correctly. For an example, if a claim had a procedure code that the physician did a blood sample and the billing specialist put the code that he did an injection. Then the company is not going to get paid correctly, because one cost more than the other one does. It is the same for the diagnosis code.
It is important to know what the difference between co-payments and co-insurance also. For an example, if a patient comes in with a co-insurance the office staff may think that the patient owes that payment when they come into the office. This usually isn’t determined until after the bill is processed. Then the insurance bills the patient after the insurance pays their part. On the other hand the co-payment is owed once the patient comes into the office. That is when the office staff must collect before the patient sees the doctor.
It is also important to know what kind of insurance the patient has. This helps the company to know who to bill for the services and if the insurance will pay for it