Health Claims Processing Terminology

Health Claims Processing Terminology

Every field seems so have its own secret set of terminology. I think it has more to do with a need by those on the inside to feel superior to those on the outside than for any real need on part of those utilizing the terms. You see it in every field. Education has it, nuclear medicine has it, lawyers have it, and even medical billing utilizes such terms.A particular phrase will come into vogue and before you know it, it has been shortened to an acronym so only those inside the field of “know” will understand. As those on the inside begin to utilize the phrase, it begins to get on the outside of the field of “know”. As more and more people learn the shorthand, those on the inside change it to something else. Same old tired concept, just a new handle.Education does it more than most. For years they relied on simple charts to get information across. Suddenly, the chart became a rubric disguised in fancy language [What is a rubric? For most educators, a rubric is a printed set of scoring guidelines (criteria) for evaluating work (a performance or a product) and for giving feedback. Credit-Rubrics.com]-a table. Same thing, just those on the inside now had an internal feeling of superiority. Don’t get me wrong, I am not picking on education, everybody creates their own little private codes.In claims processing, we used to get EOBs (Explanations of Benefits). Medicare felt superior so they would refer to theirs as EOMB (Explanation of Medicare Benefits). Like that was some grand and marvelous different thing but it was the same old tired story, just a new way of expressing it. Now they all want to say ERA (Electronic Remittance Advice). For years Georgia Medicaid called their EOB an RA (remittance advice). Again, same old tired concept except that unless you were on the inside you had no idea what they meant.Seems no one really wants to tell you what they mean, they just want to keep you guessing and let the teller feel that they are in some way superior because they have this certain knowledge that you do not have. Do not let anyone talk down to you. That is precisely what they are doing. Remember, at some point they had no knowledge of the terms and they had to learn.Next time you hear a term with which you are not familiar, slow the person down and ask them what they mean-likely they are unable to explain it in your language because they really do not know, but hold them to it until you know what they mean.I do, and I have been in this industry since 1967. I force the other party to detail what they mean. Then I slyly ask, why didn’t you say that to begin with and save us both a lot of time? To make life easier for yourself, get a little book of medical acronyms and abbreviations. It is inexpensive and available on-line. Now you too can have that feeling of I know something you do not!