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All-payer rate setting is a price setting mechanism in which all third parties pay the same price for services at a given hospital. [1] It can be used to increase the market power of payers (such as private and/or public insurance companies) versus providers, such as hospital systems , in order to control costs.
The NPI is often a common denominator between various healthcare provider identifier numbers, such as CMS Certification Number [10] (CCN; formerly OSCAR number), Employer Identification Number, and PECOS Associate Control ID [11] (PAC ID). With an increasing number of publicly available datasets containing these identifiers, some organizations ...
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed.
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
Since the late 1970s, the Maryland hospital payment system has employed an all-payer system for hospital services in which all payers pay the same amount for a given service at a particular hospital. An independent commission establishes the rate structure for each hospital.
A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided.
Single-payer healthcare is a type of universal healthcare, [1] in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer"). [ 2 ] [ 3 ] Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada ) or may own and employ healthcare ...
Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs. [49] Single-payer systems may contract for healthcare services from private organizations, or own and employ healthcare resources and personnel (as was the case in England before the introduction of the Health and Social ...