How does cost containment work in healthcare, and what strategies are used to control healthcare expenses without compromising the quality of care? Healthcare is expensive, and it’s only growing more so as medical technologies become more advanced and commonplace. To avoid unchecked medical costs, cost-containment strategies have become increasingly important in the healthcare system. Cost […]
Category: Healthcare
What is Healthcare Provider Taxonomy Code and How to Get it?
A Healthcare Provider Taxonomy Code (also known as a Taxonomy Code) is a unique alphanumeric code that identifies the healthcare provider’s specialty or classification. It is used by various healthcare organizations, insurance companies, and government agencies for administrative and billing purposes. The National Uniform Claim Committee (NUCC) and the American Medical Association (AMA) maintain and […]
What is Value Based Reimbursement in Healthcare?
Value-based reimbursement, also known as value-based payment or value-based care, is a healthcare payment model that focuses on the quality and outcomes of care rather than the quantity of services provided. It aims to incentivize healthcare providers to deliver high-quality, efficient, and cost-effective care by tying reimbursement to predefined performance measures and patient outcomes. Key […]
What are HIPAA Laws?
HIPAA stands for the Health Insurance Portability and Accountability Act, which is a federal law enacted in 1996 in the United States. HIPAA consists of several provisions that aim to protect individuals’ rights and privacy related to their healthcare information. Here are the key components of HIPAA: Privacy Rule: The HIPAA Privacy Rule establishes standards […]
What is a National Provider Identifier (NPI)?
The National Provider Identifier (NPI) is a unique identification number assigned to healthcare providers in the United States. It is a 10-digit numeric identifier that remains constant throughout a provider’s career, regardless of job changes or location. Here are some key points about the National Provider Identifier (NPI): Purpose: The NPI was established by the […]
What is an Encounter Form in Healthcare?
An encounter form, also known as a superbill or charge capture form, is a document used in healthcare to record the services provided during a patient’s visit or encounter with a healthcare provider. It serves as a summary of the visit and contains information necessary for medical billing and coding purposes. Here are the key […]
What is Claim Scrubbing / Claims Editing / Claims Validation?
Claim scrubbing, also known as claims editing or claims validation, is a process in medical billing that involves reviewing and validating healthcare claims before they are submitted to insurance companies or third-party payers for reimbursement. The purpose of claim scrubbing is to identify and resolve errors, inaccuracies, or missing information in the claims to increase […]
What is Cost Sharing in Health Insurance?
Cost sharing in health insurance refers to the portion of healthcare costs that policyholders are responsible for paying out of their own pockets. It is a way to distribute the financial burden of healthcare expenses between the insurance company and the insured individual. Cost sharing typically includes various types of payments, such as deductibles, copayments, […]
What are Bundled Payments in Healthcare?
Bundled payments, also known as episode-based payments or episode-of-care payments, are a payment model in healthcare where a single payment is made to cover all the services and care related to a specific episode of treatment or care for a patient. Instead of paying for each individual service or procedure separately, bundled payments reimburse healthcare […]
What is Account receivable in Healthcare?
In healthcare, accounts receivable (AR) refers to the outstanding payments owed to a healthcare organization by patients, insurance companies, or other third-party payers for services rendered. It represents the total amount of money that the organization is entitled to receive for the healthcare services provided but has not yet been collected. Here are some key […]