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Negative option billing is a business practice in which customers are given goods or services that were not previously ordered, and must either continue to pay for the service or specifically decline it in advance of billing. [1] This is, for example, the model on which mail order services, such as Columbia House, [2] and other book clubs are ...
Internet vendors benefit from a simplified sales model as compared to traditional brick-and-mortar stores. By storing goods remotely at a warehouse location and shipping goods directly to a consumer, significant transportation needs are eliminated both on the part of the vendor (shipping goods to stores) and by the consumer (traveling to stores).
The National Correct Coding Initiative (NCCI) is a Centers for Medicare & Medicaid Services (CMS) program designed to prevent improper payment of procedures that should not be submitted together. There are two categories of edits:
The Fair Credit Billing Act (FCBA) is a United States federal law passed during the 93rd United States Congress and enacted on October 28, 1974 as an amendment to the Truth in Lending Act (codified at 15 U.S.C. § 1601 et seq.) and as the third title of the same bill signed into law by President Gerald Ford that also enacted the Equal Credit ...
The National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers. The NUBC was formed by the American Hospital Association (AHA) in 1975. [3]
However, out-of-network medical billing has become common for privately insured patients even when they receive care in an in-network hospital, creating a substantial financial burden. [13] Surprise balance billing is when an out-of-network provider bills an individual for services that were not covered by the insurance plan.
Payment protection insurance (PPI), also known as credit insurance, credit protection insurance, or loan repayment insurance, is an insurance product that enables consumers to ensure repayment of credit if the borrower dies, becomes ill, disabled, loses a job, or faces other circumstances that may prevent them from earning income to service the debt.
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.