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  2. Medical outsourcing - Wikipedia

    en.wikipedia.org/wiki/Medical_outsourcing

    Medical outsourcing is a business process used by organizations like hospitals, nursing homes, and healthcare provider practices to obtain physician, nursing, healthcare technician, or other services in a managed services model.

  3. Medical billing - Wikipedia

    en.wikipedia.org/wiki/Medical_billing

    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.

  4. Application service provider - Wikipedia

    en.wikipedia.org/wiki/Application_service_provider

    ASP may bill on a per-use basis (on-demand outsourcing), a monthly/annual fee, or a per-labor hour basis; The advantages to this approach include: Application costs are scaled over multiple customers [2] ASP may provide more application experience than the customer's staff [2] ASP may provide application customization for the customer [2]

  5. Health care prices in the United States - Wikipedia

    en.wikipedia.org/wiki/Health_care_prices_in_the...

    As the largest single purchaser of medical services in the U.S., Medicare's fixed pricing schedules have a significant impact on the market. These prices are set based on CMS' analysis of labor and resource input costs for different medical services based on recommendations by the American Medical Association. [35]

  6. Bundled payment - Wikipedia

    en.wikipedia.org/wiki/Bundled_payment

    Level of risk sharing: a bundled payment may be structured to offer upside (a share of savings if costs are below the bundle price), downside (a share of excess costs if costs are above the bundle price), or both. Providers may bear all of the savings and/or excess costs (100% risk), or they may bear a fraction of the risk while payers continue ...

  7. Usual, customary and reasonable - Wikipedia

    en.wikipedia.org/wiki/Usual,_customary_and...

    The US government healthcare website defines usual, customary and reasonable as being "The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount."

  8. Balance billing - Wikipedia

    en.wikipedia.org/wiki/Balance_billing

    However, out-of-network medical billing has become common for privately insured patients even when they receive care in an in-network hospital, creating a substantial financial burden. [13] Surprise balance billing is when an out-of-network provider bills an individual for services that were not covered by the insurance plan.

  9. Outsourcing - Wikipedia

    en.wikipedia.org/wiki/Outsourcing

    Business process outsourcing (BPO) is a subset of outsourcing that involves the contracting of the operations and responsibilities of a specific business process to a third-party service provider. Originally, this was associated with manufacturing firms, such as Coca-Cola that outsourced large segments of its supply chain .

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