PAYER IN MEDICAL BILLING
- Primary – Private Insurance or HMO (Health Maintenance Organization)
- Secondary – Medicare
- 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.