Limitations on services, fewer covered benefits, and monetary caps all affect reimbursements. Knowing what the acronyms mean will assist clinicians in obtaining the highest level of revenues.
Denville, NJ (PRWEB) March 31, 2013
“Just because you have a coding specialist doesn’t mean you don’t need to know the abbreviations that are standard in the industry,” said Chhoda. “Those acronyms represent specific terms that will affect your reimbursements, cash flow and patient treatments.”
Many abbreviations within the healthcare industry are insurance specific. Chhoda noted that it’s essential for therapists to familiarize themselves with the specialized jargon utilized by insurance companies to ensure proper payment for services. Limitations on services, fewer covered benefits, and monetary caps all affect reimbursements. Knowing what the acronyms mean will assist clinicians in obtaining the highest level of revenues.
- CMS – is an acronym for Centers for Medicare and Medicaid Services. The CMS sets healthcare standards and payment guidelines.
- EDT – stands for electronic data transfer. An electronic medical record (EMR) system is an example, allowing healthcare professionals, medical facilities, labs and pharmacies to communicate and submit reimbursement claims electronically.
- HIPAA – is the acronym for the Health Insurance Portability and Accountability Act. It’s a measure passed by Congress to ensure patient privacy. HIPAA gives patients access to their own medical files upon completion of a written request, or those they designate.
- HMO – is a Health Maintenance Organization that assigns a primary care physician to clients and limits a patient’s treatment options by specialists. HMOs can require the insured to obtain a referral or prior authorization is the services of a specialist are required.
- INN – stands for in-network and refers to an insurance company’s network of preferred providers. Individuals usually pay less in co-pays and deductibles to INN providers.
- OON – refers to practitioners out of the insurance company’s network of preferred providers. Patients seeing OON providers are required to pay more out of their own pocket.
- POS – stands for point of service. A POS is a cross between a PPO and HMO, featuring low costs for patients who see INN providers.
- PPO – is a preferred provider organization that offers patients the freedom to choose their own specialists, physicians and even pharmacies, without the need for prior authorization.
- WC – refers to Workers’ Compensation and encompasses benefits paid to employees who sustain work-related injuries. The conditions for treatment are many and practitioners must follow specific filing requirements.
Chhoda’s new list of nine acronyms every clinician should know takes into account new laws, EMR technology and the extensive array of insurers and organizations with which practitioners will interact in their practice. A clinician’s income and the treatment provided to clients will be determined by insurance companies and being cognizant of the listed acronyms will help therapists ensure they receive the reimbursements to which they’re entitled.
Chhoda’s office can be reached by phone at 201-535-4475. For more information, visit the website at http://www.emrnews.com.
ABOUT NITIN CHHODA
Nitin Chhoda PT, DPT is a licensed physical therapist, a certified strength and conditioning specialist and an entrepreneur. He is the author of "Physical Therapy Marketing For The New Economy" and “Marketing for Physical Therapy Clinics” and is a prolific speaker, writer and creator of products and systems to streamline medical billing and coding, electronic medical records, health care practice management and marketing to increase referrals. He has been featured in numerous industry magazines, major radio and broadcast media, and is the founder of Referral Ignition training systems and the annual Private Practice Summit. Chhoda speaks extensively throughout the U.S., Canada and Asia. He is also the creator of the Therapy Newsletter and Clinical Contact, both web-based services to help private practices improve communication with patients, delivery better quality of care and boost patient retention.