Medical Billing and Coding Glossary: Terms You Will Meet in Training

Key takeaway: Job postings and exam blueprints assume you know these terms. Each is defined in one or two sentences with a pointer to the guide that goes deeper. You do not need to memorize this page before you enroll; you will meet every term in class.

Ads skip the jargon, then the first job posting is written in it. Use this as a lookup, not a textbook.

A to C

AAPC. The certifying body for the CPC, CPB, and many specialty coding credentials. See certifications.

Accounts receivable (A/R). Money owed to a provider by payers and patients. Days in A/R is a core billing metric.

Advance Beneficiary Notice (ABN). A Medicare form telling a patient that a service may not be covered and that they may be responsible for payment.

AHIMA. The American Health Information Management Association, which certifies the CCA, CCS, RHIT, and RHIA.

APC. Ambulatory Payment Classification, the grouping Medicare uses to pay hospital outpatient services.

Appeal. A formal request that a payer reconsider a denied or underpaid claim.

Audit. A review of coded charts for accuracy, often with a percent target. Remote employers ask for these scores.

Bundling. Payer rules that combine related services into one payment; billing them separately is called unbundling.

CAHIIM. The accreditor for health information programs. Required for RHIT eligibility. See RHIT.

CBCS. NHA’s Certified Billing and Coding Specialist credential. See CBCS.

CCA, CCS. AHIMA’s entry-level and advanced coding credentials. See CCA and CCS.

Clearinghouse. A service that checks and transmits electronic claims from providers to payers.

CMS-1500. The standard professional (physician) claim form.

CPC, CPC-A. AAPC’s Certified Professional Coder and its apprentice designation. See CPC.

CPT. Current Procedural Terminology, the AMA’s procedure code set. See code sets.

D to H

Denial. A payer’s refusal to pay a claim or line, with a reason code.

Downcoding. Assigning a lower-paying code than documentation supports, which costs the provider money and can still be a compliance problem if it is a pattern.

DRG. Diagnosis-related group, the case category that determines a hospital’s inpatient payment.

E/M (evaluation and management). CPT codes for office and hospital visits, leveled by complexity.

EHR. Electronic health record.

Encoder. Software that helps coders look up and validate codes.

EOB and remittance advice. The payer’s explanation of what was paid, adjusted, or denied.

HCPCS Level II. Codes for supplies, drugs, and services not in CPT, maintained by CMS.

HIPAA. The federal privacy and security law governing health information. It still applies when you code from home.

IPEDS. The U.S. Department of Education survey that supplies the school data on this site, including published institution tuition.

I to R

ICD-10-CM. The diagnosis code set. ICD-10-PCS. The inpatient procedure code set.

LCD / NCD. Local and National Coverage Determinations, Medicare rules for when a service is covered.

Medical necessity. The requirement that a service be justified by the diagnosis; the link coders and billers must make explicit.

Modifier. A two-character addition to a CPT or HCPCS code that changes its meaning or payment.

NCCI. National Correct Coding Initiative, CMS edits that flag code pairs that should not be billed together.

NHA. The National Healthcareer Association, which certifies the CBCS.

Place of service. A two-digit code on a professional claim that says where the service happened (office, hospital, telehealth, and so on).

Prior authorization. Payer approval required before certain services are covered.

Practicum / PPE. Supervised practice hours some programs require. Ask whether the school places you and whether it can be remote.

Query. A coder’s written request to a provider to clarify documentation. Non-leading questions only.

RHIT. Registered Health Information Technician, an AHIMA credential requiring a CAHIIM-accredited degree.

S to Z

SOC 29-2072. The BLS occupation code for medical records specialists, the group that includes billers and coders. See medical records specialist.

Superbill. A provider’s encounter form listing the services and diagnoses for a visit.

Timely filing. The payer’s deadline for submitting a claim after the date of service.

UB-04. The standard institutional (facility) claim form.

Unbundling. Billing separately for services that a payer considers one payment. See bundling.

Upcoding. Reporting a higher-paying code than documentation supports; a compliance violation.

This site is not affiliated with AAPC, AHIMA, NHA, CAHIIM, CMS, or the AMA. Credential rules change; confirm current definitions with the issuing body.