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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.
In January 2014, Illinois became the first state to mandate the use of EVV when the Department of Human Services required it for its home services program. [6] As of June 1, 2015, the Texas Health and Human Services Commission mandates that electronic visit verification be used for all home healthcare visits billed to the state. [ 3 ]
The Sunshine Act requires manufacturers of drugs, medical devices, biological and medical supplies covered by the three federal health care programs Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) to collect and track all financial relationships with physicians and teaching hospitals and to report these data to the Centers for Medicare and Medicaid Services (CMS).
The primary purpose of the ACA was to increase coverage to the American people either through public or private insurance and control healthcare costs. The Congressional Budget Office (CBO) estimated that the ACA would reduce the number of uninsured by 32 million, increasing coverage for the non-elderly citizens from 83 to 94 percent.
The Health Insurance Premium Payment Program (HIPP) is a Medicaid program that allows a recipient to receive free private health insurance paid for entirely by their state's Medicaid program. A Medicaid recipient must be deemed 'cost effective' by the HIPP program of their state. Ultimately, the program was made optional, and its use is minimal ...
As of 2022, Caremark Rx, Express Scripts, OptumRx, Humana, Prime Therapeutics, and MedImpact Healthcare Systems were the six largest public PBMs that control 95% of the market, while the top three controlled 80% of the market. [41] As of 2024, the top 3 controlled a market of almost $600 billion. [6]
HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001. [9] [11] In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011. [12] In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most. [13]
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