ReimbursementPregunta 76 de 100
Balance billing occurs when a provider bills the patient for:
a.Only the copayment
b.The difference between the provider's charge and the payer's allowed amount
c.The full amount that insurance already paid
d.The provider's contractual write-off
Explicación
Balance billing is charging the patient the gap between the provider's full charge and the payer's allowed amount. For participating providers this practice is generally prohibited by contract, and certain federal and state protections limit surprise balance billing. The patient may still owe legitimate cost-sharing such as deductibles and coinsurance.
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Preguntas relacionadas de este tema
- In a fee-for-service reimbursement model, the provider is paid:
- A patient's total 'out-of-pocket maximum' represents:
- A provider bills $2,000 for a service. The payer's allowed amount is $1,200, and the provider is a participating (in-network) provider. What is the contractual adjustment (write-off)?
- The 'aging' of accounts receivable in a medical practice refers to:
- When posting an insurance payment from a remittance advice, the biller should:
- A patient statement sent for collections should clearly show:
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