DRG – Diagnosis Related Group
DRG: DRG system payment depends on the following factors: DRG-Related Weight: Hospital Payment Calculation:
Medical Billing
Medicare and its types, Part A, Part B, Part C & Part D Services
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 Steps
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
Medicare Deductible & Premium
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
Medicaid – QMB, SLMB, QI & QDWI Program
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
Clinical Laboratory Improvement Amendments (CLIA)
1) CLIA Waived Test 2) CLIA Non-Waived Test
Managed Care Organization (MCO) Plans
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