Discover the importance of the Place of Service in health insurance, including common locations like hospitals and physicians' offices. Understand how it impacts your coverage and reimbursement.
Learn about the term 'Encounter' in health insurance, which refers to a meeting with a healthcare provider where the insured receives any type of service.
Learn what a Superbill is in health insurance. It lists every service provided by a doctor, aiding in accurate billing and claims.
Learn about the customary charge, the average cost of medical procedures used to determine Medicare benefits, and its impact on health insurance.
Learn about the Modified Fee for Service model in health insurance, where reimbursements for actual procedure costs are made up to a specific maximum. Understand its impact on healthcare payments.
Learn the role and importance of a Participating Provider in Health Insurance, including their approval process in Medicare and how they are compensated.
Learn about what an Explanation of Benefits (EOB) is, how it itemizes health services, the incurred costs, the payments made by your insurer, and your responsibilities.
Learn about the Fee for Service (FFS) reimbursement model in health insurance, where health care professionals are paid based on individual services provided.
Learn about precertification authorization in general insurance, its importance, and how it helps in managing treatment costs effectively.
Learn about reasonable and customary charges in health insurance, what they mean for your healthcare costs, and how they relate to provider charges and Medicare-approved costs.
Learn about Resource Based Relative Value Scale (RBRVS), a method used by Medicare to determine compensation for doctors, and its implications in the health insurance industry.
Explore the concept of prospective reimbursement in health insurance where providers receive annual payments based on previously established rates. Learn how this system impacts healthcare providers and patients.
Learn about the Date of Service in health insurance, which refers to the specific day a health care practitioner attends to or treats an insured individual.
Discover how Diagnosis Related Groups (DRGs) are used to determine compensation for medical providers in the health insurance industry.
Learn about Relative Value Unit (RVU) - a vital metric used in health insurance to determine surgical costs and values through multiplication with a conversion factor.
