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  2. Resource-based relative value scale - Wikipedia

    en.wikipedia.org/wiki/Resource-based_relative...

    For example, in 2005, a generic 99213 Current Procedural Terminology (CPT) code was worth 1.39 Relative Value Units, or RVUs. Adjusted for North Jersey, it was worth 1.57 RVUs. Using the 2005 Conversion Factor of $37.90, Medicare paid 1.57 * $37.90 for each 99213 performed, or $59.50.

  3. Current Procedural Terminology - Wikipedia

    en.wikipedia.org/wiki/Current_Procedural_Terminology

    It is necessary for most users of the CPT code (principally providers of services) to pay license fees for access to the code. [19] In the past, AMA offered a limited search of the CPT manual for personal, non-commercial use on its web site. [20] CPT codes can be looked up on the AAPC (American Academy of Professional Coders) website. [21]

  4. Medical billing - Wikipedia

    en.wikipedia.org/wiki/Medical_billing

    The current version, ICD-10, will transition to ICD-11 in 2025, requiring updated coding practices. [14] CPT Codes: Created by the American Medical Association (AMA), Current Procedural Terminology (CPT) codes correspond to the procedures or treatments performed by the healthcare provider.

  5. Ambulatory Payment Classification - Wikipedia

    en.wikipedia.org/wiki/Ambulatory_Payment...

    APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. A part of the Federal Balanced Budget Act of 1997 made the Centers for Medicare and Medicaid Services create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services -analogous to the ...

  6. Health reimbursement account - Wikipedia

    en.wikipedia.org/wiki/Health_Reimbursement_Account

    A Health Reimbursement Arrangement, also known as a Health Reimbursement Account (HRA), [1] is a type of US employer-funded health benefit plan that reimburses employees for out-of-pocket medical expenses and, in limited cases, to pay for health insurance plan premiums.

  7. Reimbursement - Wikipedia

    en.wikipedia.org/wiki/Reimbursement

    Reimbursement is the act of compensating someone for an out-of-pocket expense by giving them an amount of money equal to what was spent. [1]Companies, governments and nonprofit organizations may compensate their employees or officers for necessary and reasonable expenses; under US [2] [3] law, these expenses may be deducted from taxes by the organization and treated as untaxed income for the ...

  8. Capitation (healthcare) - Wikipedia

    en.wikipedia.org/wiki/Capitation_(healthcare)

    Capitation is a payment arrangement for health care service providers. It pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.

  9. Diagnosis code - Wikipedia

    en.wikipedia.org/wiki/Diagnosis_code

    The diagnoses codes in particular the Principal Diagnoses and Additional Diagnoses can significantly affect the total funding that a hospital may receive for any patient admitted. [5] Ethically, this highlights the fact that the assignment of the diagnoses code can be influenced by a decision to maximize reimbursement of funding.