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A Customer integrated system (CIS) is an extension or hybrid of the transaction processing system (TPS) that places technology in the hands of the customer and allows them to process their own transactions. [1] CIS represents a way of doing business at substantial savings; customers save time and organizations can lower their human resource ...
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. [1] This bill is called a claim. [2]
The Healthcare Information and Management Systems Society (HIMSS) was established in 1961 as the Hospital Management Systems Society (HMSS) by Edward J. Gerner and Harold E. Smalley. The first national convention was held in Baltimore in 1962, and the organization moved its headquarters to Chicago in 1964.
Physicians and other health care providers lack the necessary actuarial, underwriting, accounting and finance skills for insurance risk management, but their most severe problem is the greater variation in their estimates of the average patient cost, which leaves them at a financial disadvantage as compared to insurers whose estimates are far ...
Healthcare providers across the United States are struggling to get paid following the week-long ransomware outage at a key tech unit of UnitedHealth Group, with some smaller providers saying they ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
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The Knox-Keene Health Care Service Plan Act of 1975 is a set of Californian laws that regulate Healthcare Service Plans. Under these laws, pharmacy benefit managers with contracts to Health care service plans are required by law to be registered with the Department of Managed Health Care to disclose information. [58] SB 966: Pharmacy benefits