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Brief Summary on Medical Billing and Coding PDF Print E-mail
Written by David Andrews   
Tuesday, 05 October 2010 09:42
Have you ever wondered how physicians and hospitals get usually paid? Well, probably not because in the United States, we normally do not pay for medical care directly; rather our medical insurer pays for it. We just visit our physician’s office or the hospital and provide information about our health insurance. We might be asked to pay co-pay, a token amount, but that’s fraction of the total medical bill.

Healthcare providers including physicians, hospitals, and other healthcare facilities after providing treatment submit our medical bill to the medical insurer. After approval of the bill, the medical insurer pays our healthcare provider directly.

Medical insurers reimburse healthcare providers according to necessary processes or procedures performed on the patient. It is the responsibility of the healthcare provider to supply the medical insurer with supporting evidence that the procedure was necessary. The healthcare provider does not get paid unless the supporting documentation accompanies the bill. This sounds logical until we understand that each health insurer requires different types of supporting documents.

This looks to be a well-oiled, effective system for addressing medical expenses at least from the patient’s perspective. However, this system can be a nightmare for the healthcare providers who care for hundreds of patients daily with each patient having a different medical coverage and requiring a different treatment.

Think of trying to assemble a detailed bill with different supporting documents for each of the hundreds of patients treated by a healthcare provider every day. It can become a nightmare and any error will delay the payment.

Fortunately, healthcare providers can rely on Medical Billing and Coding Professionals, commonly known as “Medical Insurance Specialists” who know how to prepare bills and supporting documents so that the medical insurers will authorize payment.
Last Updated on Tuesday, 05 October 2010 09:57
 
Common Terms Encountered with Medical Billing, Medical Coding, and Insurance Issues! PDF Print E-mail
Written by David Andrews   
Monday, 04 October 2010 12:08
Advance Beneficiary Notice (ABN): This is also known as “waiver of liability.” This report is given to Medicare beneficiaries to formally inform the patient that Medicare is not likely to pay for certain services or items that they know or have a reason to believe Medicare will determine to be Medically unnecessary to the patient, and therefore will not pay for. The notice must be given to the patient before services are performed.

Allowed Expenses: The maximum amount a plan pays for a covered service. See Usual and Customary Charges.

Ambulatory Care: Medical services provided on an outpatient (non-hospitalized) basis.

Assignment of Benefits: It is an authorization addressing an insurer to make payment straightaway to the provider of benefits, such as physician or dentist, rather than to the insured. The doctor’s office can bill and receive payment for services directly from the insurer.

Ambulatory Care: Medical services provided on an outpatient (non-hospitalized) basis.

Ambulatory Patient Classifications (APC): A structure or system for classifying outpatient services and procedures for purposes of payment.

Assignment & Authorization: This form allows the hospital to bill insurances on the patient’s behalf and receive payment directly from the payor. A form signed by the patient showing insurance plans assigned and their billing priority. Signature on the form also authorizes the release of medical information to the Medical Center or Facility, in the event the patient is transferred to the mentioned facility.

Benefits: Medical services for which your insurance plan will pay, in full or in part.

Beneficiary: An individual who is eligible for receiving benefits under an insurance policy or plan.
Last Updated on Wednesday, 13 October 2010 13:52
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ICD-10 Corner

9 benefits of ICD-10

1. Measuring the quality, safety and efficacy of care
2. Designing payment systems and processing claims for reimbursement
3. Conducting research, epidemiological studies, and clinical trials
4. Setting health policy
5. Operational and strategic planning and designing healthcare delivery systems
6. Monitoring resource utilization
7. Improving clinical, financial, and administrative performance
8. Preventing and detecting healthcare fraud and abuse
9. Tracking public concerns and assessing risks of adverse public health events

More details..

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