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.
What’s a Premium, Really? Think of your premium as a subscription fee. It’s the amount you pay every month—whether or not you use any medical services. Key facts about premiums: 🔍 “Why is my premium so high?”If your plan offers broad coverage, low deductibles, or access to a large provider network, your premium will reflect … Read more
12 – Working Aged Beneficiary or Spouse with Employer Group Health Plan 13 – End-Stage Renal Disease Beneficiary in the 30-Month Coordination Period with an Employer’s Group Health Plan 14 – No-fault insurance, including auto, is primary (any no-fault insurance) 15 – Workers’ Compensation … Read more
TRICARE: VETERANS AFFAIRS / ADMINISTRATION (VA):
1) These are the Medicare programs established to help low-income beneficiaries where Medicaid pays their Medicare Part A & Part B premium, Medicare coinsurance, and Medicare Deductible. 2) Below are the Medicare programs and their covered benefit, 3) You will find a scenario where a claim was paid by Medicare as primary and Medicaid denied … Read more
For Scenarios related to deductibles click on pdf. Deductibles.pdf
New Patient A new patient is one who visits to take a service for the first time or one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years. New Patient Codes – 99202, 99203, 99204, 99205 Established … Read more
1) CLIA Waived Test 2) CLIA Non-Waived Test
Managed care organization (MCO) is a type of health insurance that have contracts with healthcare providers to help members to provide services at low cost. Providers are contracted with health insurance under MCO plans and based on these plans, the cost of the patient’s health services is dependent. An individual can select any plan and … Read more
