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Medical billing is a payment practice within the United States healthcare system. The process involves the systematic submission and processing of healthcare claims for reimbursement. Once the services are provided, the healthcare provider creates a detailed record of the patient's visit, including the diagnoses, procedures performed, and any ...
Prospective payment system. A prospective payment system ( PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided. It includes a system for paying hospitals based on predetermined prices ...
Direct primary care. In the United States, direct primary care ( DPC) is a type of primary care billing and payment arrangement made between patients and medical providers, without sending claims to insurance providers. It is an umbrella term, incorporating various health care delivery systems that involve direct financial relationships between ...
A 2006 PriceWaterhouseCoopers report for America's Health Insurance Plans (a health-insurer trade association) used the 2 percent figure and an extrapolation from the Kessler and McClellan report to estimate that the combined cost of insurance and defensive medicine accounts for 10 percent of total health care costs in the U.S.
In the United States, health insurance marketplaces, [1] also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act (ACA, known colloquially as "Obamacare") at ACA health exchanges, where ...
In 2015 CMS identified 254 quality measures for which providers may choose to submit data. The measures map to U.S. National Quality Standard (NQS) health care quality domains: [4] Communication and Care Coordination; Community/Population Health; Effective Clinical Care; Efficiency and Cost Reduction; Patient Safety