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Billing, reimbursement, and collection. After a patient encounter, the services are coded and a claim is submitted to the third-party provider. The claim will either
Billing, reimbursement, and collection. After a patient encounter, the services are coded and a claim is submitted to the third-party provider. The claim will either be rejected or paid. Rejected claims must be corrected and resubmitted. We have discussed some of the reasons for errors in coding in a previous lesson. Once the claim is approved and paid an explanation of benefits (EOB) report is sent to the patient and the healthcare provider by the insurance carrier to inform them of the final reimbursement determination, explaining the decision, and reimbursement due to the provider. Claims may be by paper or electronic means. The following list contains terms related to billing and reimbursement. Explain two of the following terms related to billing and reimbursement and provide an example for each. Cycle Billing Collection agency Write-off Scrubber program Computerized billing CMS-1500
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