The payments which are used by managed care organizations to control and manage health care costs are known as Capitation Payments. These payments control use of health care resources by putting the physician at financial risk for services given to patients. Similarly, managed care organizations measure the rates of resource […]
HCFA 1500
The HCFA 1500 form is considered to be professional paper claims form which is utilized by physicians and other medical service providers to submit claims for payment from Medicare carriers. The HCFA 1500 claim form enables the medical facilities to submit the health insurance claims to insurance carriers like Medicare and […]
How to Bill Under a Group Practice?
Many times significant queries are raised about the billing for providers who are working for a group. Here, it is integral to understand not just the difference between the rendering provider NPI and the billing provider NPI, but also how the provider is set up with each and every insurance carrier. Well, […]
Billing Tips for Non-Credentialed Providers
NONCREDENTIALED PROVIDERS When a new or established provider has not been credentialed by an insurance company, it is believed to be the most common situation. This usually happens when a provider is employed straight out of residency or from another practice (in- or out-of-state). The query is also raised when […]
Certified Urgent Care Criteria
Facilities will receive a Certification of Category 1 or Category 2 depending on their staffing model: Category 1 = licensed physician (MD/DO) on site during all posted hours of operation Category 2 = licensed provider (MD/DO or NP/PA) on site during all posted hours of operation (mixed models) All facilities, […]
URGENT CARE CLINIC QUALIFYING QUESTIONNAIRE
Definition of General Urgent Care services – an Urgent Care that is designed to handle routine illnesses and injuries such as colds, coughs, sinus infections, flu, cuts, sprains, strep throat, stitches, minor burns, bronchitis, earaches, rashes, urinary tract infections and sports injuries. They also take X-rays, remove small foreign bodies […]
Difference Between PCP, Urgent Care and ER
Primary Care Physician Urgent Care Center Emergency Room What? A primary care physician is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions Urgent care is a category of walk-in clinic focused on the delivery of ambulatory care in a dedicated […]
What is Superbill?
Superbills are also commonly known as Encounter Forms, Charge Slips, or Fee Tickets. These are the pre-printed forms that are utilized to document the charges, through procedure codes, linked with a sufferer visit along with supporting data, like diagnosis codes, that are needed to bill insurance companies. Superbills save up […]