What are Third-party Administrators in Medical Billing?
Third-party administrators (TPAs) are intermediaries who either operate as a network or access networks to price claims on behalf of companies. When working with patients in a Medical Office, there are many different types of Insurance options. Each type of insurance has it’s own set of advantages and disadvantages, and it is important to understand…
What is an Exclusive Provider Plan in Medical Billing?
One of the most confusing types of insurance providers is known as a Exclusive Provider Plan (often abbreviated to the acronym EPO). When working with patients in a Medical Office, there are many different types of Insurance options. Each type of insurance has it’s own set of advantages and disadvantages, and it is important to…
What is a Health Maintenance Organization in Medical Billing?
One of the most common types of insurance providers are known as a Health Maintenance Organizations (often described by the acronym HMO). When working with patients in a Medical Office, there are many different types of Insurance options. Each type of insurance has it’s own set of advantages and disadvantages, and it is important to…
What is a Preferred Provider Organization in Medical Billing?
One of the most common types of insurance providers is known as a Preferred Provider Organization (often described by the acronym PPO). When working with patients in a Medical Office, there are many different types of Insurance options. Each type of insurance has it’s own set of advantages and disadvantages, and it is important to…
What is the benefit of Value-based care for doctors?
When working with patients to bill their medical insurance, it can be confusing to understand the different systems available. Since the introduction of Value-Based Care, the confusion has increased. Most of the information available today about Value-Based Care is written by insurance providers explaining the core benefits to patients. While this is helpful, it may…
How do you bill for an Inpatient Consultation in Medical Billing?
In medical billing terms, a ‘consultation’ is simply a visit that’s been requested by another physician, healthcare provider, or healthcare entity. This could also include a social worker, attorney, or even an insurance company. Sometimes these are also called inpatient consultations. With inpatient consultation visits, the most important thing for you to remember as a…
How do you Document the Complexity of Medical Decision Making?
When making medical decisions, there is a great deal of complexity that doctors must be aware of. The levels of Evaluation and Management services recognize four types of medical decision making. These four types of decision making complexity: – straightforward – low complexity – moderate complexity – high complexity As a guide, you may wish…
What are Medical Decision Making (MDM) Guidelines in Medical Billing?
When working on Medical Billing in a medical practice, there is a lot of protocol that must be followed for the billing to be managed accurately. One important area is the Medical Decision Making (MDM) Guidelines Evaluation & Management (E&M) Guidelines state that each patient encounter must include a medical history, an examination, and medical…
The Four levels of Medical Examination. A Guide to Medical Billing.
When working on Medical Billing in a medical practice, there is a lot of protocol that must be followed for the billing to be managed accurately. One important area is understanding the Four Levels of Medical Examination, as per the 1997 Guidelines determined by the CMS. The levels of Evaluation and Management services are based…
What is the difference for Level One, Level Two and Level Three Codes for Hospital Medical Billing?
When doing Medical Billing for Patients who are visiting the hospital, there are different levels of codes that you must select depending upon the diagnosis. Choosing codes to report hospital visits by a physician can be a challenge for even the most experienced medical billing coders. In a hospital environment, there are Level One, Level…
What is the difference between Inpatient and Outpatient codes in Medical Billing?
When working in a medical practice or hospital on medical billing, there is a lot of important detail that must be understood to process a clean claim. One of the most important considerations that defines the correct code choice is whether the patient is an inpatient or outpatient. Here’s the way to determine the difference:…
What is Evaluation and Management coding in Medical Billing?
When working on the Medical Billing in a Doctors office, there is a lot of Medical Billing Jargon and Terminology that you need to understand. One term that is used a lot is Evaluation and Management (E&M) Coding. Evaluation and management coding (sometimes abbreviated to E/M coding or E&M coding) is a medical coding process…
What is an Evaluation and Management (E&M) Visit in Medical Billing?
When working with medical billing for insurance companies there can be a lot of confusion about the Medical Billing Terminology used. One term that is commonly used is E&M visit, which is short form for Evaluation and Management Encounter. This is essentially referring to a doctor’s visit, or a consultation (a visit requested by another…
What is a Super-Bill in Medical billing?
When working on the Medical Billing in a Doctors office, there is a lot of Medical Billing Jargon and Terminology that you need to understand. One term that is used a lot is Super-Bill. They are the main source for creating healthcare claims that are later submitted to insurance companies for reimbursement. The super-bill is…
What is covered by Tricare for Veterans? A Guide to Medical Billing.
When managing the Medical Billing for your medical practice, the better you understand the payment process, the better you can care for your patients. Your understanding of what a patient will owe and what will be covered can help them navigate the confusing world of medical insurance. An area of confusion for veteran patients in…
