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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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Understanding Superbill PDF Print E-mail
Written by David Andrews   
Wednesday, 06 October 2010 15:04
Superbill
Superbill is an itemized form used by healthcare providers for reflecting provided services. Although the superbill form is not unified, and it is created /modified depending on healthcare provider specialty, type of rendered services, additional requirements, as well as ease of handling, there is a set of obligatory attributes, relevant to all superbill types. Superbill is the main data source for creation of healthcare claim, which will be submitted to payers (insurances, funds, programs) for reimbursement.

Superbill form comprises of 4 main divisions with mandatory fields to be completed for accurate claim creation:

1. Provider information:
- Rendering Provider name and Degree
- Service location
- Referring/Ordering/Attending Physician first and last name (upon necessity) with NPI (National provider Identifier).
- Signature

2. Patient information:
- Patient's first and last name
- Patient DOB
- Insurance information (Insurance name/and ID)
- Date of first symptom (upon necessity)
- Last date seen (upon necessity)

Last Updated on Friday, 08 October 2010 12:38
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Page 15 of 19

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..

Inspirational line

"At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.— Albert Schweitzer"

If your actions inspire others to dream more, learn more, do more and become more, you are a leader. — John Quincy Adams

Life Quotes, Proverbs, and Sayings

"Don't limit yourself. Many people limit themselves to what they think they can do. You can go as far as you mind lets you. What you believe, you can achieve. -Mary Kay Ash"

Health Tips

Exercising When Obese

If you are obese, then check with your physician before initiating any exercise program. Our suggestion, search for a low impact aerobic program as a starter.

Fat Free vs. Calorie Free

Just because a product is fat free, doesn't mean it is calorie free. In fact, fat free or reduced fat products can have as many, if not more, calories per serving than regular products. So, yes, you do need to watch your fat intake. But remember that calories count, too.

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Started by a group of young, enthusiastic physicians in the year 1999, Vision Infonet was incorporated in the State of Illinois in 2001. As a vibrant enterprising organization,  we began our journey towards the world leadership in providing the IT enabled back-office services to medical facilities.....more

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