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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.
Large urban labor-related rate $2,809.18 Large urban non-labor-related $1,141.85 Wage index 1.4193 Standard Federal Rate: labor * wage index + non-labor rate $5,128.92 DRG relative weight (RW) factor 1.8128 Weighted payment: Standard Federal Rate * DRG RW $9,297.71 Disproportionate Share Payment (DSH) 0.1413 Indirect medical education (IME) 0.0744
RBRVS assigns procedures performed by a physician or other medical provider a relative value which is adjusted by geographic region (so a procedure performed in Manhattan is worth more than a procedure performed in Dallas). This value is then multiplied by a fixed conversion factor, which changes annually, to determine the amount of payment.
Chargemasters include thousands of hospital services, medical procedures, equipment fees, drugs, supplies, and diagnostic evaluations such as imaging and blood tests. [6] Each item in the chargemaster is assigned a unique identifier code and a set price that are used to generate patient bills. [6]
A medical calculator is a type of medical computer software, whose purpose is to allow easy calculation of various scores and indices, presenting the user with a friendly interface that hides the complexity of the formulas. Most offer further information such as result interpretation guides and medical literature references. [1]
Evaluation and management coding (commonly known as E/M coding or E&M coding) is a medical coding process in support of medical billing. Practicing health care providers in the United States must use E/M coding to be reimbursed by Medicare, Medicaid programs, or private insurance for patient encounters. [1]
APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. A part of the Federal Balanced Budget Act of 1997 made the Centers for Medicare and Medicaid Services create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services -analogous to the ...
Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice including veterinarians. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports.