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The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice. But POS health insurance does differ from other managed care plans. Enrollees in a POS plan are required to choose a primary care physician (PCP) from within the health care network; this PCP becomes their "point of service". The PCP may ...
A POS plan uses some of the features of each of the above plans. Members of a POS plan do not make a choice about which system to use until the service is being used. In terms of using such a plan, a POS plan has levels of progressively higher patient financial participation, as the patient moves away from the more managed features of the plan.
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 ...
The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
The acronym HCPCS originally stood for HCFA Common Procedure Coding System, a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). Prior to 2001, CMS was known as the Health Care Financing Administration (HCFA).
Unlike EPO members, however, PPO members are reimbursed for using medical care providers outside of their network of designated doctors and hospitals. However, when they use out-of-network providers PPO members are reimbursed at a reduced rate that may include higher deductibles and co-payments, lower reimbursement percentages, or a combination ...
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The standard defines documents for electronic transmission of medical prescriptions in the United States. The NCPDP Telecommunications standard includes transactions for eligibility verification, claim and service billing, predetermination of benefits, prior authorization, and information reporting, and is used primarily in the United States.