Feb 25, 2010 | Medical billing basics
What is referring physician? The physician who refers a patient for a service or supply that they cannot directly provide. Often a physician will refer a patient when it becomes necessary for them to see a specialist or to have a specific service or test performed. In...
Feb 25, 2010 | Medical billing basics
What is the difference between a Skilled Nursing Facility and Nursing Facility? The distinction is based on whether skilled care or custodial care is provided.Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled...
Feb 25, 2010 | Medical billing basics
What is the difference between in-network and out-of-network providers?In-network provider:An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates.Out-of-network provider: An...
Feb 25, 2010 | Medical billing basics
NON PAR PROVIDERS Non-participating Providers” do in fact participate with Medicare. Non-par providers generally do not accept assignment on a regular basis; however, can choose to accept assignment on a case-by-case basis and be reimbursed at the non-par level....
Feb 25, 2010 | Medical billing basics
PAR ProvidersParticipating provider – A provider (e.g., hospital, group practice, health care facility or individual Clinician) who has a participation agreement in effect with Oxford to render medical services to covered persons in a particular Oxford Plan and...
