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
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
