Understanding Pre-Existing Conditions and Their Impact on Medical Billing and Insurance Coverage Having a pre-existing condition can make it difficult to find, afford, and receive adequate medical coverage. Knowing the laws that affect pre-existing conditions and how to navigate the health insurance process can help you make sure you get the medical care you need. […]
Category: Medical Billing
What is provider-based billing and how does it relate to medical billing for healthcare services provided by hospital-affiliated clinics and facilities?
Understanding Provider-Based Billing in Healthcare Provider-based billing (PBB) is an important part of healthcare billing and reimbursement for healthcare services provided by hospital-affiliated clinics and facilities. As the name implies, this system of billing allows providers to bill and be reimbursed for the services they provide based on their provider-status relationship with a hospital. How […]
How does fee schedule negotiation affect the financial agreements between healthcare providers and payers and what strategies are commonly used in these negotiations?
The Pros and Cons of Fee Schedule Negotiation Fee schedule negotiation is a common practice between healthcare providers and payers when negotiating the level of reimbursement for services provided. This type of negotiation can affect the financial agreements between the two parties, and is often used as a way to ensure both parties are adequately […]
Who is a Primary Care Provider (PCP) in healthcare, and how does their role impact medical billing and patient care coordination?
The Role of Primary Care Providers (PCPs) in Healthcare Primary care providers (PCPs) are essential to the healthcare industry in many ways. They coordinate patient care and are responsible for medical billing activities, helping to ensure that healthcare services are properly provided, billed, and tracked. In this article, we will discuss how PCPs impact medical […]
What is concurrent coding in medical billing, and how does it help maintain the accuracy of healthcare claims by coding multiple diagnoses and procedures?
Concurrent Coding in Medical Billing and How It Can Enhance Healthcare Claims Accuracy When it comes to medical billing, concurrent coding can be a useful technique to increase accuracy in the process. Concurrent coding refers to the practice of coding multiple diagnoses and procedures for a single claim. It enhances the accuracy of healthcare claims […]
What is a subscriber number in medical billing, and how does it uniquely identify individuals covered by health insurance plans?
Understanding Subscriber Numbers in Medical Billing Medical bills can be complicated documents, and it’s important for healthcare consumers to understand the details of their bills. One item frequently listed on these bills is a subscriber number – and it’s important to know what it means, and how it uniquely identifies individuals covered by health plans. […]
How is the reimbursement rate determined in medical billing, and how does it vary for different healthcare services and providers?
Understanding Medical Billing Reimbursement Rates When providers offer medical services, it is important that they are adequately reimbursed for these services. The amount they will be reimbursed is determined by a number of factors, including the type of service provided and the provider’s location and credentials. Here, we will explore what goes into determining a […]
What are the key differences between inpatient billing and outpatient billing in the context of medical billing?
The Key Differences between Inpatient and Outpatient Billing When it comes to medical billing, there is a distinct difference between inpatient and outpatient billing. It is important for medical professionals to understand these differences and how they impact their billing procedures. Inpatient Billing Inpatient billing typically covers the expenses associated with a hospital stay including […]
What are the key considerations and differences in commercial insurance billing compared to other types of medical billing, and what challenges may arise in this context?
Commercial Insurance Billing: Understanding The Key Considerations and Differences As medical billing practices evolve, understanding the nuances of commercial insurance billing is so increasingly important. While there are a number of similarities between billing for private pay patients versus those with commercial insurance, there are several key differences that must be taken into consideration. Billing […]
Accountable Care Organizations (ACOs) in Medical Billing
How do Accountable Care Organizations (ACOs) impact medical billing and the delivery of healthcare services? Accountable Care Organizations (ACOs) have been developed to better manage healthcare delivery and improve patient care. ACOs allow providers to coordinate services across multiple care settings – from hospitals and doctor offices to long-term care facilities. They also set up […]