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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. [1] This bill is called a claim. [2]
Selling insurance products under UnitedHealthcare, and health care services under the Optum brand, it is the world's ninth-largest company by revenue and the largest health care company by revenue. The company is ranked 8th on the 2024 Fortune Global 500. [4] UnitedHealth Group had a market capitalization of $460.3 billion as of December 20, 2024.
The Sunshine Act requires manufacturers of drugs, medical devices, biological and medical supplies covered by the three federal health care programs Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) to collect and track all financial relationships with physicians and teaching hospitals and to report these data to the Centers for Medicare and Medicaid Services (CMS).
Healthcare providers from across the sector were also in attendance and voiced their concerns about the ongoing financial and operational impacts of the Change cyberattack. [60] [61] As of April 16, 2024, UnitedHealth Group had advanced payments of over $6 billion in assistance to health care providers affected by the cybersecurity attack. [62]
Bundled payment is the reimbursement of health care providers on the basis of expected costs for episodes of care. It has been portrayed as a middle ground between fee-for-service reimbursement and capitation (in which providers are paid a "lump sum" per patient regardless of how many services the patient receives), given that risk is shared ...
Health care providers often receive payments for their services rendered from health insurance providers. In the United States, the Department of Health and Human Services defines a health care provider as any "person or organization who furnishes, bills, or is paid for health care in the normal course of business." [1] [2]
Other portal applications are integrated into the existing healthcare provider's website. Still others are modules added onto an existing electronic medical record (EMR) system. What all of these services share is the ability of patients to interact with their medical information via the Internet.
If actual quarterly spending by health care providers is under budget, the providers receive a bonus; if actual quarterly spending is over budget, payment to the providers is partially withheld. [27] The model is currently being tested in three pilot sites which are scheduled to end in 2011. [27] [28]