Running a medical office is a formidable endeavor. Its challenges include complexity, privacy, and plain old risk. Not only do you have to provide great care, you have to protect your patients’ information and get paid for your services. Medical billing can feel like the unloved child of any practice, but we have good news for you: you can make it one of the smoothest-running, dependable aspects of your practice with Complete Practice Services. We work tirelessly to provide billing and record programs that are vigorous and intuitive enough to facilitate success in practices of any size. It’s what we do, and we love it.
We don’t simply create programs; we train our clients to use them. This personal transfer of information is crucial to your success, and it’s part of why we have this blog. In our last blog, we shared some common medical billing terms and what they mean. It won’t surprise you that one blog was not enough space to cover them all! Today, we want to share some more terms and clarify just what they mean. Read on!
This is a pretty common term, and it is the process for getting an insurance company to pay more (or any) of a certain medical claim. Both patients and care providers can use the appeals process, but it can only happen after a claim has been rejected or denied.
Independent Practice Association (IPA)
This is a formal organization of healthcare professionals or physicians. IPAs will have contracts with HMOs, who contract them for help providing healthcare. The individual practices of IPA members don’t have to be part of the HMO.
You will commonly find capitation arrangements in HMOs. A capitation arrangement is an agreement between a healthcare provider and an insurance company. The insurance company pays the provider a fixed amount for each patient. The amount paid is determined by the patients history, age, race, and health risks.
Explanation of Benefits (EOB)
This is the literature attached to a processed claim. It goes into detail on what the insurance company will cover, and is the insurance company’s way of communicating with both the patient and the care provider. If a claim is denied, the EOB is the first place to look for explanation.
We are sure you are familiar with this, but it is a common term we want to cover. It is a government health insurance plan that was founded in 1965. It offers coverage to people with disabilities and people over 65 years old.
Preferred Provider Organization (PPO)
In this type of health insurance plan, the insurance company gets to decide who gets included in the acceptable provider network. It’s subscription-based and is quite common.
Complete Practice Resource is proud to be Santa Barbara’s premier EHR provider. We work hard every day to be the best ally that any medical practice could have. We aspire to be a source of clarity, convenience, and peace of mind. Contact us to learn more about what we offer!