Insurance is a contract between two parties: the insurer and the insured. The insured agrees to pay a premium in exchange for protection from financial loss caused by specific events outlined in the policy. An insurance claim is the process of seeking financial compensation from the insurer after a covered loss occurs. The purpose of insurance is to transfer the risk of loss from the insured to the insurer, and an insurance claim is the mechanism by which this transfer occurs... Read more

Insurance verification is the process of confirming that a patient’s health insurance coverage is active and in good standing with the insurance provider. The process typically involves gathering information about the patient’s insurance policy, including the policy number, group number, and the name of the insurance provider.

Insurance verification is a critical step in the healthcare revenue cycle management process, a... Read more

Medical billing is an essential aspect of healthcare administration, and it involves a series of complex processes that aim to ensure that healthcare providers receive timely payments for services rendered to patients. One of the critical components of medical billing is the AR follow-up process, which involves tracking and resolving outstanding claims that have been denied or remain unpaid. We'll delve deeper into AR follow-up in medical billing and explore its importanc... Read more

Medical billing accounts receivable is a term used to describe the amount of money that healthcare providers are owed for services rendered to patients, but which has not yet been collected. Essentially, it refers to the outstanding invoices or bills that have been sent to insurance companies or patients, but for which payment has not been received.

In the healthcare industry, billing for services is often complex and time-consuming, involving a ran... Read more

Medical billing can be a complex and confusing process, especially for those who are not familiar with the terminology and procedures involved. Two terms that are often used in medical billing are "claim" and "encounter." While these terms may seem interchangeable, there are important differences between the two that can impact how healthcare providers are reimbursed for their services.

A claim is a request for p... Read more

Medical billing can be a complex process, involving many steps and various stakeholders. Two important players in this process are the claim scrubber and the clearinghouse. While both are essential to ensuring accurate and timely payment for healthcare services, they perform distinct roles. We'll explore the difference between a claim scrubber and a clearinghouse in medical billing.

First, let's define what each term means. A claim scrubber is a software pro... Read more

When it comes to medical billing, it can be confusing to understand the various terms and concepts involved. Two terms that often cause confusion are deductible and copayment. While both are used to describe the amount that a patient is responsible for paying, there are key differences between the two.

Deductible

A deductible is the amount that a patient must pay before their insurance coverage kicks in. F... Read more

In the world of medical billing, there are two primary payment models: fee-for-service and capitation. These models differ significantly in how healthcare providers receive payment for their services. Understanding the differences between the two can help patients and healthcare providers make informed decisions about their care and payment options.

Fee-for-Service Payment Model

The fee-for-service payment model Read more