What’s the Difference Between Managed Medicaid and Traditional Medicaid? Managed Medicaid and traditional Medicaid are two different systems of providing health care services to members of the program, though both are funded by the federal government. Managed Medicaid is a service that is administered by private companies and has been designed to improve the quality […]
Category: Medical Billing
What are hospital-acquired conditions (HACs) and how do they impact medical billing and healthcare costs for patients and facilities?
Hospital-Acquired Conditions (HACs) and Their Impact on Medical Billing and Healthcare Costs Hospital-acquired conditions (HACs) are defined as a medical condition that a patient develops while in the hospital. These conditions can affect medical billing and healthcare costs for both patients and facilities. The Cost for Patients When a patient acquires a HAC, the cost […]
How do value-based contracts influence medical billing and what are the key components and incentives in such contracts?
Navigating Value-Based Contracts: Key Components and Incentives in Medical Billing Medical billing is a complex system that requires deep knowledge and understanding of regulations and laws to get it right. Value-based contracts are becoming increasingly popular in the healthcare industry as a way to move away from traditional fee-for-service models and pay more attention to […]
What are Local Coverage Determinations (LCDs) and how do they influence the medical billing process for Medicare services and procedures?
Understanding Local Coverage Determinations (LCDs) and How it Influences the Medical Billing Process for Medicare Services Medicare covers a wide range of services and procedures, helping to ensure that Americans receive the healthcare they need no matter their age or financial status. But, before Medicare pays for any medical services, it has certain criteria that […]
What are the key elements of E/M (Evaluation and Management) documentation guidelines in medical billing and how do they ensure accurate and comprehensive documentation of patient encounters?
E/M Documentation Guidelines for Accurate Medical Billing When it comes to medical billing, accurate and comprehensive documentation of patient encounters is essential in order to ensure appropriate reimbursement. The E/M (Evaluation and Management) documentation guidelines are an important part of this process. Key Elements of E/M Documentation Guidelines These guidelines provide clear instructions on what […]
What is a compliance plan in the context of medical billing and how does it help healthcare organizations prevent fraud waste and abuse?
How Compliance Plans Help Healthcare Organizations Prevent Fraud, Waste, and Abuse Compliance plans are an essential tool for healthcare organizations when it comes to preventing fraud, waste, and abuse. In the context of medical billing, a compliance plan is a formal detailed strategy designed to make sure that billing practices are in line with relevant […]
What is a provider network and how does it affect patient choices and medical billing processes?
Understanding Provider Networks and Their Impact Understandably, healthcare is a complex issue, but one of the key areas to understand is provider networks and their effect on patient choices and medical billing processes. In this post, we’ll explore what a provider network is, what impact it has, and how it affects patients and medical billing. […]
How does clinical documentation improvement enhance the accuracy of medical billing and coding and why is it important?
Understanding The Benefits of Clinical Documentation Improvement in Enhancing Medical Billing and Coding Accuracy The quality of medical billing and coding is critically important in reporting patient data and in ensuring proper reimbursements for treatments. Accurate coding directly influences the accuracy of the reimbursement process and the accuracy of the claim. That’s why clinical documentation […]
How does self-funded insurance differ from traditional insurance models and what implications does it have for medical billing and claims?
What is self-funded insurance? Self-funded insurance is a type of health insurance plan that offers employers flexibility and potential savings from traditional insurance plans. In a self-funded insurance plan, employers take on most of the risk of providing health benefits to their employees—paying their claims directly rather than through an insurer. Self-funding gives employers greater […]
What is the Healthcare Fraud and Abuse Control Program (HCFAC) and how does it combat fraudulent activities in healthcare billing and claims?
Combating Fraudulent Activities in Healthcare Billing and Claims with HCFAC Healthcare fraud and abuse is a major problem for healthcare providers, which can affect patients, insurance companies, and government healthcare programs. The Healthcare Fraud and Abuse Control Program (HCFAC) is a joint effort between the U.S. Department of Health and Human Services and the Department […]