Medical billing is the process of submitting claims to insurance companies or patients for reimbursement of medical services, involving coding, claim generation, and following up on payments to ensure healthcare providers get paid.
In medical billing, the term subscriber refers to the primary individual who holds a health insurance policy. The subscriber is responsible for maintaining the insurance plan and ensuring that premiums are paid. The subscriber can also extend coverage to dependents, such as spouses or children, depending on the policy’s terms. Roles and Responsibilities of a … Read more
Eligibility Criteria: To be eligible for Medicaid, an individual must be a U.S. citizen or a permanent legal resident for at least five continuous years and also meet at least one of the following Medicaid eligibility criteria: Federal Poverty Level Guidelines: Claim Submission:
1. Age-Based Eligibility 2. Work History or Spousal Coverage 3. Early Enrollment Options 4. Medicare Parts & Enrollment Essentials Part Overview Eligibility / Timing Part A Hospital Insurance Free with 40 credits; otherwise paid Part B Medical (Doctors, Outpatient) Enrollment typically at 65; late penalties if delayed Part C Medicare Advantage (via private insurers) Must … Read more
Payment calculation without sequestration, Billed Amount = $40.00 Allowed amount = $20.00 Paid amount = $16.00 Patient responsibility (Coinsurance) = $4.00 Payment calculation with sequestration, The sequestration … Read more
The birthday rule is a health insurance coordination policy used to determine which parent’s plan will be the primary payer when a newborn or child is covered under both parents’ health insurance. Despite how it sounds, the birthday rule doesn’t prioritize age—it goes by calendar date. In Simple Terms: This rule is widely followed by … Read more
Rejection: Below are a few most common rejections with resolution steps: 1) Policy ID invalid / Patient or Subscriber not identified: I) When a claim is billed with an incorrect policy ID: Insurance Policy ID Format Policy ID Examples 1199 SEIU FUNDS 10 digits number 1234567890 AARP 11 digits number 12345678901 Aetna 10 digits … Read more
1. Patient Name 2. Patient DOB 3. Referring Doctor 4. Rendering Doctor 5. Service Location Information 6. Exam time 7. CPT code with description 8. Indication: It indicates the sign and symptoms … Read more
