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In principle, there is a very good reason for the standardization of medical terminology: it reduces one of the most common and preventable potential causes of serious error: miscommunication.

Non-Standard Medical Terminology in the Insurance Review Process

From the perspective of the medical insurance claims professional, non-standard medical terminology is equally problematic. The insurance claims process is highly codified (literally) into numerical designations for specific procedures and expenses. In combination with the degree to which the process relies on computer functions and databases encoded with those specific designations, that process is even more susceptible to error from non-standard communication than healthcare delivery, although rarely with comparable harm to patients. However, in some cases, the miscommunication caused by unnecessary non-standard language can indeed result in serious harm or even death, such as where crucial services are denied for coverage improperly as the result of issues of terminology that are not discovered in time to correct them (Reid, 2009).

Ultimately, insurance claims reviewer share in the profound responsibility to avoid errors of this type by enforcing proper coding and terminology requirements instead of accepting non-standard language from physicians and other healthcare professionals.

References:

Fawcett, J. (2005). Analysis and Evaluation of Conceptual Models of Nursing, Upper

Saddle River, NJ: Pearson.

Reid, T. (2009). The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York: Penguin Group.

Taylor, C., Lillis, C., and LeMone, P. (2005). Fundamentals of Nursing: The Art and Science.

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