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 […]
Category: Insurance
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 are Remittance Advices or Remittance Advice Statements?
Remittance advices, also known as remittance advice statements or payment explanation statements, are documents provided by insurance companies or third-party payers to healthcare providers or medical billing companies. These documents serve as a communication and payment notification for the healthcare services that have been processed and paid by the payer. Remittance advices provide detailed information […]
What does Claims adjudication mean in medical billing?
Claims adjudication is the process by which insurance companies review, evaluate, and make a determination on healthcare claims submitted by healthcare providers. It involves the examination of the claim for accuracy, completeness, medical necessity, and compliance with the insurance policy’s terms and conditions. The goal of claims adjudication is to determine the appropriate payment or […]
What is EOB in medical billing?
An Explanation of Benefits (EOB) is a document provided by an insurance company to the policyholder and the healthcare provider, detailing the outcome of a medical claim. It serves as a summary of how the insurance company processed the claim, the amounts billed, the amounts covered, and any remaining balances or patient responsibilities. Here’s what […]