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Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4] The payor returns the claim back to the medical biller and the biller evaluates how much of the bill the patient owes, after insurance is taken out.
Massachusetts General Hospital (Mass General or MGH) is a teaching hospital located in the West End neighborhood of Boston, Massachusetts. [4] It is the original and largest clinical education and research facility of Harvard Medical School/Harvard University, and houses the world's largest hospital-based research program with an annual research budget of more than $1.2 billion in 2021. [5]
Given the $15,197 average cost of a stay in Mass. and average hourly private sector wage of $33.92, it would take 386 work hours to pay the bill.
Massachusetts General Hospital (Founding Member) Mass General Brigham Health Plan (acquired in 2011 as Neighborhood HealthPlan, [56] named AllWays Health Partners from 2019–2021) [57] Mass General Brigham Healthcare at Home; McLean Hospital (founded by MGH) MGH Institute of Health Professions; Nantucket Cottage Hospital (acquired in 2006) [58]
The device utilized to perform the procedure, called EsophyX, was developed by EndoGastric Solutions. The first TIF procedure utilizing the device was performed in 2005. [8] The device received European Union CE mark in 2006 and United States Food and Drug Administration issued initial 510(k) clearance in 2007. [2] [9]
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions. The use of Level III codes was discontinued on December 31, 2003, in order to adhere to consistent coding standards.
The per-oral endoscopic myotomy, or POEM, is a minimally invasive surgical procedure for the treatment of achalasia wherein the inner circular muscle layer of the lower esophageal sphincter is divided through a submucosal tunnel. [1] This enables food and liquids to pass into the stomach, a process that is impaired in achalasia.
The device for carrying out the procedure was originally developed by a company called Curon which obtained FDA approval for the device in 2000 but then went bankrupt in 2006; the device was brought back to market by Mederi Therapeutics in 2010. [2] [6] The procedure costs between $3,000 and $4,000 as of 2004. [7]