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Every health organization has a standard fee schedule that it discounts for volume health services payers such as Blue Cross or Aetna.  When one agrees to accept a discounted fee schedule, it is not legal to bill the patient the difference between your standard fee...

Bad debt is accounts receivable (money owed) that cannot be collected from the patient and is written off as uncollectable.  If you turn a patient account over to a third-party collection agency, the account is considered bad debt and is written off.  If money is...

Capitation is a payment structure which is the opposite of traditional fee-for-service reimbursement.  In fee-for-service (FFS), a practice receives a payment for every visit to the practice a covered patient makes.  With capitation, the practice is paid a certain...

A carve-out is a group of services that are not covered under the primary contract, but are addressed under a separate agreement.  For instance, a practice may have a contract with a payer whereby the all services will be reimbursed to the practice at a specific...

Case management is a department/program wherein registered nurses and licensed social workers coordinate care for patients who require additional services with the goal of attaining the best health outcomes at the most reasonable cost. The Case Management Society of...

Charge capture is the process of entering services rendered into a billing system so the services can be billed to an insurance company or payer or to an individual for payment.  Charge capture can be accomplished by having the care provider: Mark a form (called an...

Charity care (no fee or sliding scale reduced fees) is determined prior to the patient receiving services and is based on an inability to pay.  Some practices consider patients eligible for care at no or reduced fee if their household income is at or below 200% of the...

A clearinghouse is an organization that receives claims data from practice management systems and repackages it in electronic or paper format to send to payers in bulk.  Clearinghouses started out as independent organizations, but now many are owned by vendors who...