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:
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
CPT codes are classified into 3 categories: I) Category I – This is the main category of CPT that used by providers to represent their different services and reimburse the payment. Below are the 6 different sections of this category with specialties and CPT range, 1. Anesthesia Services: 00100 – 01999 & 99100 – 991502. Surgery: 10004 – 699903. Radiology … Read more
A copay is a fixed amount that a patient is required to pay for a specific medical service or prescription, at the time the service is provided. It is denoted as copay (PR-3) This amount is typically predetermined by the patient’s health insurance plan and does not change based on the total cost of the … Read more
