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Achieving a high clean claims rate is a key metric for measuring the efficiency of the billing cycle. Creation of the claim is where medical billing most directly overlaps with medical coding because billers take the ICD/CPT codes used by the medical coders and creates the claim. Step 6: Monitoring payor Adjudication [4]
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Accredited Claims Adjuster: ACA Accredited Claims Professional: ACP Accredited Claims Professional Candidate: ACAc Associate in Claims: AIC Applied Microbial Remediation Technician: AMRC Casualty General Adjuster: CGA Certified Claims Adjuster: CCA Certified Claims Professional: CCP Certified Claims Professional Candidate: CCPc Chartered ...
The acronym HCPCS originally stood for HCFA Common Procedure Coding System, a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). Prior to 2001, CMS was known as the Health Care Financing Administration (HCFA).
A clinical coder—also known as clinical coding officer, diagnostic coder, medical coder, or nosologist—is a health information professional whose main duties are to analyse clinical statements and assign standardized codes using a classification system.
the service performed—the date of the service, the description and/or insurer's code for the service, the name of the person or place that provided the service, and the name of the patient; the doctor's fee, and what the insurer allows—the amount initially claimed by the doctor or hospital, minus any reductions applied by the insurer
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