There are three main types we will overview.
The first is Health Management Organizations (HMOs).
The premium for HMOs is lower, but allows for almost no flexibility when it comes to choosing providers outside of network.
Medical care is prearranged with a list of medical services that will be provided.
What is the billing process in healthcare?
Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim.
What are professional claims in healthcare?
Professional Billing for Medical Services
Professional billing is responsible for the billing of claims generated for work performed by physicians, suppliers, and other non-institutional providers for both outpatient and inpatient services.
What are the types of medical coding?
Two common medical coding classification systems are in use — the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). ICD is the standard international system of classifying mortality and morbidity statistics, and it’s used by more than 100 countries.
What is third party billing in healthcare?
A third-party payer is an entity that pays medical claims on behalf of the insured. Examples of third-party payers include government agencies, insurance companies, health maintenance organizations (HMOs), and employers.