While medical coders and billers both contribute to the healthcare revenue cycle, their roles serve different but complementary purposes. Medical coders translate doctors’ notes, test results, and procedures into standardized codes like ICD-10 and CPT. These codes are essential for insurance documentation and accurate patient records. In contrast, medical billers take those codes and prepare … Read more
In medical billing, authorization and referral serve different purposes, though both are crucial for insurance coverage and patient care. Simply put, authorization is permission from the insurance company for a service, while a referral is a recommendation from a primary care provider (PCP) to see a specialist. Let’s break down the details to help you … Read more
Definition Understanding Reversals in Medical Billing Understanding Refunds in Medical Billing Quick Comparison: Reversal vs. Refund Aspect Reversal Refund Timing Before payment settles After payment is finalized Purpose Cancel wrong/unauthorized charges Return overpayment or correct billing errors Impact on Accounting Minimal correction needed Requires adjustments and audit trails Common Triggers Duplicates, wrong authorization Overbilling, service … Read more
In simple terms: A deductible is the amount you must pay for covered health services before your insurance starts paying. The out-of-pocket maximum is the most you’ll have to pay in a year — after which your insurance covers 100% of covered costs. Both terms are key to understanding how much you’ll spend on healthcare … Read more
Introduction When billing for services, selecting the correct Place of Service (POS) code is critical to ensure clean claims and proper reimbursement. One frequently used—but sometimes misunderstood—POS code is 20, which represents an Urgent Care Facility. Let’s break down what POS 20 is, when it should be used, and how it affects billing and reimbursement. … Read more
Definition Place of Service Code 11 is used on professional claims (CMS-1500 form) to indicate that the service was provided in a physician’s office, or a clinician-owned or leased space used to treat patients on an outpatient basis. CMS definition: “Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, … Read more
What is Place of Service 02 POS 02 stands for Place of Service Code 02, which is used by healthcare providers to show that telehealth services were given somewhere other than the patient’s home. This could be a clinic, hospital, or other medical facility. Key Points: Common in rural or dialysis center settings. It tells … Read more
When billing for outpatient medical services, choosing the correct Place of Service (POS) code can make or break your reimbursement. Among the most debated are POS 2 (Telehealth Provided Other than in Patient’s Home) and POS 10 (Telehealth Provided in Patient’s Home). These two codes may seem similar, but their implications for billing, reimbursement, and … Read more
In health insurance, individuals can choose from different plans based on their needs. Three common types are HMO, PPO, and POS. These plans offer healthcare coverage. However, they vary in structure, flexibility, cost, and access to services. Here’s a breakdown of each: 1. Health Maintenance Organization (HMO) An HMO, or Health Maintenance Organization, is a … Read more
POS code 1 designates the “Office” setting in healthcare, where physicians provide medical services in their own offices, clinics, or non-hospital facilities that deliver routine ambulatory care. When to Use Place of Service Code 1 POS Code 1 should be used in the following scenarios: Key Considerations for Using POS Code 1 Examples of Using … Read more
