Medical billing is an administrative payment procedure within the U.S. healthcare system. The method involves a health care provider, getting medical insurance quotes from a patient, submitting a claim, following up with payment. The payment can either come from the health insurance provider or directly from the patient. Both parties, the health insurance company and the health care provider have to agree on a settlement price before the process can be completed.
Another option to receive payment directly from the patient is through HMOs or Health Maintenance Organizations. This arrangement was created to encourage patients to receive routine health care from qualified doctors and hospitals. A patient is usually required to maintain membership in one of these plans in order to receive medical billing. People who are not members of HMOs often find it difficult to receive payment when they make claims.
In addition to receiving payment from the patient or HMO, some facilities also allow claims to be submitted by independent vendors. Claims may be made by independent vendors for services received from outside sources without having to submit the same claims under the HMO plan. The facility does not pay for these services but does require that the same code is used for the service and that payment be made for the same services. It is important to note that independent vendors cannot submit claims under any health insurance plan and must use a different code from the HMO.
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