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The medical billing process is a process that involves a third party payer, which can be an insurance company or the patient. Medical billing results in claims, which are billing invoices for medical services rendered to patients. The entire procedure involved in this is known as the billing cycle, sometimes referred to as Revenue Cycle Management.
Medical billing, Nosology. A clinical coder —also known as clinical coding officer, diagnostic coder, medical coder, or nosologist —is a health information professional whose main duties are to analyse clinical statements and assign standardized codes using a classification system. The health data produced are an integral part of health ...
Certified Medical Reimbursement Specialist (CMRS) is a voluntary national credential that was created specifically for the medical billing professional. The American Medical Billing Association (AMBA) has been providing this industry certification and designation for nearly a decade. The CMRS designation is awarded by the Certifying Board of ...
The insurance which pays on behalf of insureds negotiate with medical providers, sometimes using government-established prices such as Medicaid billing rates as a reference point. This reasoning has led for calls to reform the insurance system to create a consumer-driven healthcare system whereby consumers pay more out-of-pocket. [231]
The Health Insurance Portability and Accountability Act of 1996 ( HIPAA or the Kennedy – Kassebaum Act [1] [2]) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. [3] It aimed to alter the transfer of healthcare information, stipulated the guidelines ...
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