Fee Schedule Analysis and Auditing The insurance allowed amount or the fee schedule is determined by various factors such as insurance plan, provider in-network or out of network status, ACO, PHO, geographic practice cost index, etc. If the practice did not keep up with the ever-changing fee schedul...

Medical Coding Certification Certified Professional Coder (CPC) The CPC medical coding certification validates proficiency in the correct application of CPT, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes used for coding and billing for medical claims in a physician’s...

               Provider Directory It is profile which shows the healthcare provider information in a directory structure on the healthcare payer’s website. Information like providers name, specialty, servicing address, phone and fax numbers will be listed there according to the patient’s...

                                WOL (Waiver of Liability) A medical liability waiver is an advance written notice to the beneficiary used by medical professionals when the services being provided are found not to be medically necessary.  A completed and signed copy of the Waiver of ...

                                 Clearing House What is Clearing House? In medical billing, companies that function as intermediaries who forward medical claims information from healthcare providers to insurance payers are known as clearinghouses. In what is called claims scrubbing,...

     Difference between Copay,                Co-Insurance and Deductible Copay– A predetermined rate the patient pays for health care services at the time of care. Copay are due at the time the patient receives a health care service. Deductible – The deductible is the amount ...