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.
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
Let’s not overcomplicate this. If you’ve ever looked at a patient’s Medicare claim and wondered, “Who handles the secondary payment?”, you’re asking the right question. That’s exactly where crossover claims come into play. In this guide, we’ll unpack what a crossover claim really is, how it flows through the system, what makes it different from … 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
DRG: DRG system payment depends on the following factors: DRG-Related Weight: Hospital Payment Calculation:
Medicare is a federal health insurance program mainly for people 65 and older, and for younger individuals with disabilities or serious conditions like kidney failure. If you’re a kidney patient, understanding Medicare helps you get the care you need without surprise costs. Here are the Medicare basics: Key LSI Keywords: federal health insurance, Medicare eligibility, … Read more
Revenue Cycle Management is used in the healthcare system of the United State of America. It is useful to track the revenue for providers for the services taken by patients. It starts with a patient appointment when a patient needs any treatment or patient has any illness and ends up with the resolution of service … Read more
