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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.
An evaluation published in late 2007 showed that 117 patients who received "ProvenCare" had a significantly shorter total length of stay (resulting in 5% lower hospital charges), a greater likelihood of being discharged to home, and a lower readmission rate compared with 137 patients who received conventional care in 2005.
Usual, customary, and reasonable (UCR) is an American method of generating health care prices, [1] described as "more or less whatever doctors decided to charge". [2] According to Steven Schroeder , Wilbur Cohen inserted UCR into the Social Security Act of 1965 "in an unsuccessful attempt to placate the American Medical Association ". [ 3 ]
The chargemaster may be alternatively referred to as the "charge master", "hospital chargemaster", or the "charge description master" (CDM). [4] [5] It is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. [3] [6] It is described as "the central mechanism of the revenue cycle" of a hospital ...
Secondary capitation is a relationship arranged by a managed care organization between a physician and a secondary or specialist provider, such as an X-ray facility or ancillary facility such as a durable medical equipment supplier whose secondary provider is also paid capitation based on that PCP's enrolled membership.
• Dial-Up - These are charges for members with limited dial-up access who used more dial-up minutes than included in the monthly plan. These charges accrue by the minute at a rate of up to $2.99 per hour, so if it’s larger than normal, it means you probably used more dial-up minutes than included in your monthly plan.
A certified class of 60,750 uninsured patients who received care from the Scripps Health hospital system alleged that Scripps imposed excessive fees and charges for medical treatment. [2] The final settlement approved in June 2008 reduced charges historically and prospectively, bringing prices to the levels that other payors paid or will pay ...
Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. [1]
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