by Bob Whaley | Apr 24, 2010 | Definitions
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...
by Bob Whaley | Apr 24, 2010 | Definitions
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...
by Bob Whaley | Apr 21, 2010 | Definitions
A benefit year is the 12-month period for which a patient is subscribed to a plan, and during which the payer has agreed to pay for services according to the patient’s plan.
by Bob Whaley | Apr 21, 2010 | Definitions
Accepting assignment means that: you will accept as payment in full the allowed amount established by the payer (Medicare or any other payer you are contracted with) and the payment will be sent directly to the provider for services rendered. Providers may accept...
by Mary Pat Whaley | Apr 18, 2010 | Definitions
270 ”” eligibility & benefit inquiry – Is the patient an insured of this payer? 271 ”” eligibility & benefit response (response to 270) – A yes or no response that the patient is insured 276 ”” claims status inquiry (follows 837 submission) 277 ””...
by Mary Pat Whaley | Apr 18, 2010 | Definitions
the patient has private insurance but there is no vaccine benefit the patient has private insurance but the vaccine benefit is limited to certain vaccines the patient has private insurance but the vaccine benefit caps at a specific dollar amount
