by Bob Whaley | Apr 25, 2010 | Definitions
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...
by Bob Whaley | Apr 24, 2010 | Definitions
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...
by Bob Whaley | Apr 24, 2010 | Definitions
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...
by Bob Whaley | Apr 24, 2010 | Definitions
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...
by Bob Whaley | Apr 24, 2010 | Definitions
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...
by Bob Whaley | Apr 24, 2010 | Definitions
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...
