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Certified Medical Reimbursement Specialist (CMRS) is a voluntary national credential that was created specifically for the medical billing professional. The American Medical Billing Association (AMBA) has been providing this industry certification and designation for nearly a decade.
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.
A clinical coder—also known as clinical coding officer, diagnostic coder, medical coder, or nosologist—is a health information professional whose main duties are to analyse clinical statements and assign standardized codes using a classification system.
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Insurance Claims Expert / Insurance Claims Expert Prof./ Practitioner: ICE; ICEP Litigation Specialist / Litigation Consultant: LS-LC Legal Principles Claims Specialist: LPCS Master General Adjuster: MGA Master Public Adjuster: MPA Property Claims Law Associate: PCLA Property General Adjuster: PGA Registered General Adjuster: RGA
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In the United States, health insurance providers often hire an outside company to handle price negotiations, insurance claims, and distribution of prescription drugs. Providers which use such pharmacy benefit managers include commercial health plans , self-insured employer plans, Medicare Part D plans , the Federal Employees Health Benefits ...
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.
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