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Medical billing is a payment practice within the United States healthcare system. The process involves the systematic submission and processing of healthcare claims for reimbursement. Once the services are provided, the healthcare provider creates a detailed record of the patient's visit, including the diagnoses, procedures performed, and any ...
Single-payer healthcare is a type of universal healthcare [1] in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer"). [2] [3] Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare ...
A National Provider Identifier ( NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes: the payee, the ...
Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
A 2009 study done at Harvard Medical School with Cambridge Health Alliance by cofounders of Physicians for a National Health Program, a pro-single payer lobbying group, showed that nearly 45,000 annual deaths are associated with a lack of patient health insurance. The study also found that uninsured, working Americans have an approximately 40% ...
National health insurance ( NHI ), sometimes called statutory health insurance ( SHI ), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country.
Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [1] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic ...