CO 24 denial code in medical billing (Capitation)
What are Capitation Payments and how to work on the denial? A capitation payment plan is agreed upon between an insurer and a medical provider to pay periodic payments to …
SCENARIO’S
How does HMO, PPO, EPO, and POS plan varies from each other
What are HMO, PPO, EPO, and POS? The simple answer is all those come under managed care, each has its own specification with pros and Cons. with the patient benefits, …
Difference between underpayment and overpayment in medical billing
What is Underpayment and overpayment in medical billing The exact answer is if the claim paid more than the expected Contracted allowed amount then it is called Overpayment. Similarly, If …
Workers’ compensation insurance USA (2022)
What is workers’ compensation insurance and why do we need it? In the United States, workers’ compensation coverage pays for medical treatment and a percentage of wages if the employee …
Coordination of Benefits -Claim denied as need to update COB
What is the Coordination of benefit? Coordination of Benefits -In general, the patient has many plans like a primary plan, secondary plan, Tertiary plan. These plans are Coordinated and Provisioned …
Claims Denied For No Prior Authorization on file
Introduction of authorization in medical billing There is a big difference between prior authorization and retro authorization in medical billing. Retro authorization only applies to claims that have already been …
Medical Record Denial and HIPAA Act 1996
What is Medical Record Denial in medical billing? Medical Record Denial – Medical records are a written form of description of the treatment. For claiming insurance medical records are much …
Patient is not Eligible on Date of service
Important factors of the denial Treatment is done post the policy termination date. The date of service doesn’t fall within the effective and the termination date. The patient fails to …
Participating provider VS Non participating provider
Difference between Participating providers Non participating providers The participating provider can get 80 percent of claims endorsed by Medicare. 20 percent from the medicare coinsurance of patients. But nonparticipating providers …
What are Mutually Exclusive Procedures in Medical Billing ?
Mutually Exclusive Procedure Mutually exclusive procedures are defined as a set of procedures codes that cannot perform together. In other words, a Mutually exclusive procedure is based on the code …
