PAYER IN MEDICAL BILLING

  1. Primary – Private Insurance or HMO (Health Maintenance Organization)
  2. Secondary – Medicare
  3. Tertiary – Medicaid

REVENUE CYCLE MANAGEMENT

  • Involves managing of claims, payment and billing.
  • Is also called a billing cycle.

WHAT IS PRIOR AUTHORIZATION?

  • (also known a pre-authorization) is the process of getting an agreement from the payer to cover specific services before the service is performed.
  • Normally, a payer that authorizes a service prior to an encounter assigns an authorization number that you need to include on the claim when you submit it for payment.

WHAT IS CLEARING HOUSE?

  • Medical billing clearing houses take claim information from a billing service or provider, check the claims for errors, and send this claim information electronically to insurance companies. Claims sent electronically are paid much faster than paper claims.