|
Medical Billing
Medical billing, a payment process in the Healthcare in the United States, United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed. This bill is called a claim. Because the U.S. has a mix of government-sponsored and private healthcare, health insurance companies - otherwise known as payors - are the primary entity to which claims are billed for physician reimbursement. The process begins when a physician documents a patient's visit, including the diagnoses, treatments, and prescribed medications or recommended procedures. This information is translated into standardized codes through medical coding, using the appropriate coding systems such as ICD-10-CM and Current Procedural Terminology (CPT). A medical biller then takes the coded information, combined with the patient's insurance details, and forms a claim that is submi ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Healthcare In The United States
Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population Health insurance coverage in the United States, lacks health insurance. The United States List of countries by total health expenditure per capita, spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. In 2022, the United States spent approximately 17.8% of its Gross Domestic Product (GDP) on healthcare, significantly higher than the average of 11.5% among other high-income countries. Coverage varies widely across the population, with certain groups, such as the elderly, disabled and low-income ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Copay
A patient's copayment or copay is the patient's share of the cost for goods or services rendered, with the other share ("co" = with) paid by the patient's insurance company. The patient's co-payment is usually paid directly to the provider, but is instead paid indirectly through their insurance company in the case of Medicare Part D patients enrolled in the Medicare Prescription Payment Plan, which began on January 1st, 2025. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after the deductible up to a certain limit. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usually contribute towards any policy out-of-pocket maximum, whereas coinsurance payments do. Insurance companies use copayments to share health care costs to prevent moral hazard ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
National Uniform Billing Committee
The National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers. The NUBC was formed by the American Hospital Association (AHA) in 1975. All the major national provider and payer organizations participate in discussions and decisions on policy and guidelines. In 1982, after much work and debate, the UB-82 emerged as the endorsed national uniform bill. After an 8-year moratorium on change, the UB-82 was replaced by UB-92, and became the standard for billing paper institutional medical claims in the United States, until creation of the UB-04. With the onset of HIPAA The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy– Kassebaum Act) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medically Unlikely Edit
A Medically Unlikely Edit (MUE) is a US Medicare unit of service claim edit applied to Medical claims against a procedure code for medical services rendered by one provider/supplier to one patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The patient is most often Disease, ill or Major trauma, injured and in need of therapy, treatment by a physician, nurse, op ... on one day. Claim edits compare different values on medical claim to a set of defined criteria to check for irregularities, often in an automated claims processing system. MUE are designed to limit fraud and/or coding errors. They represent an upper limit that unquestionably requires further documentation to support. The ideal MUE is the maximum unit of service for a code on the majority of medical claims. MUE is part of the National Correct Coding Initiative (NCCI) to address coding methodologies. The NCCI policies are based on coding ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
International Statistical Classification Of Diseases And Related Health Problems
The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnostics, diagnosis. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating authority for health within the United Nations System. The ICD was originally designed as a health care classification system, providing a system of diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. This system is designed to map health conditions to corresponding generic categories together with specific variations; for these designated codes are assigned, each up to six characters long. Thus each major category is designed to include a set of similar diseases. The ICD is published by the WHO and used worldwide for morbidity and mortality statistic ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Healthcare Common Procedure Coding System
The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks") is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT). History The acronym ''HCPCS'' originally stood for ''HCFA Common Procedure Coding System'', a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). Prior to 2001, CMS was known as the Health Care Financing Administration (HCFA). HCPCS was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care. Such coding is necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner. Initially, use of the codes was voluntary, but with the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for transactions invo ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Electronic Medical Record
An electronic health record (EHR) is the systematized collection of electronically stored patient and population health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. For several decades, EHRs have been touted as key to increasing quality of care. EHR combines all patients' demographics into a large pool, which assists providers in the creation of "new treatments or innovation in healthcare delivery" to improve quality outcomes in healthcare. Combining multiple types of clinical data from the system's health records has helped clinicians identify and stratify ch ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Care
Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physical and mental impairments in people. Health care is delivered by health professionals and allied health professions, allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, wikt:secondary care, secondary care, tertiary care, and public health. Access to health care may vary across countries, communities, and individuals, influenced by social and economic conditions and health policy, health policies. Providing health care services means "the timely use of personal health services to achieve the best possible health outcom ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Clinical Coder
A clinical coder—also known as clinical coding officer, diagnostic coder, medical coder, or nosologist—is a health information professional whose main duties are to analyse clinical statements and assign standardized codes using a classification system. The health data produced are an integral part of health information management, and are used by local and national governments, private healthcare organizations and international agencies for various purposes, including medical and health services research, epidemiological studies, health resource allocation, case mix management, public health programming, medical billing, and public education. For example, a clinical coder may use a set of published codes on medical diagnoses and procedures, such as the International Classification of Diseases (ICD), the Healthcare Common procedural Coding System (HCPCS), and Current Procedural Terminology (CPT) for reporting to the health insurance provider of the recipient of the care. ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Group Purchasing Organizations
In the United States, a group purchasing organization (GPO) is an entity that is created to leverage the purchasing power of a group of businesses to obtain discounts from vendors based on the collective buying power of the GPO members. Many GPOs are funded by administrative fees which are paid by the vendors that GPOs oversee. Some GPOs are funded by fees paid by the buying members. Some GPOs are funded by a combination of both of these methods. These fees can be set as a percentage of the purchase or set as an annual flat rate. Some GPOs set mandatory participation levels for their members, while others are completely voluntary. Members participate based on their purchasing needs and their level of confidence in what should be competitive pricing negotiated by their GPOs. Group purchasing is used in many industries to purchase raw materials and supplies, but it is especially common practice in the grocery industry, health care, electronics, industrial manufacturing and agricul ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
HuffPost
''HuffPost'' (''The Huffington Post'' until 2017, itself often abbreviated as ''HPo'') is an American progressive news website, with localized and international editions. The site offers news, satire, blogs, and original content, and covers politics, business, entertainment, environment, technology, popular media, lifestyle, culture, comedy, healthy eating, young women's interests, and local news featuring columnists. It was created to provide a progressive alternative to conservative news websites such as the Drudge Report. The site contains its own content and user-generated content via video blogging, audio, and photo. In 2012, the website became the first commercially run United States digital media enterprise to win a Pulitzer Prize. Founded by Arianna Huffington, Andrew Breitbart, Kenneth Lerer, and Jonah Peretti, the site was launched on May 9, 2005, as a counterpart to the Drudge Report. In March 2011, it was acquired by AOL for US$315 million, with Arianna ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medical Billing Infographic
Medicine is the science and practice of caring for patients, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others. Medicine has been practiced since prehistoric times, and for most of this time it was an art (an area of creativity and skill), frequently having connections to the religious and philosophical beliefs of local culture. For example, a medicine man would apply herbs and say prayers for healing, or an ancie ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
