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Are you struggling to understand your medical bill? Bills from hospital visits and treatments can be very complex. Every test, procedure, and treatment need to be clearly marked on the bill in a way that can be easily understood. This is why the healthcare industry uses standardized codes. But to the uninitiated, these codes can … Read more

Medicare severity-diagnosis-related groups, abbreviated as MS-DRGs, are categories of inpatient hospital stays. The Medicare system uses them to determine reimbursements for hospitals, skilled nursing facilities, and hospices. A hospital stay can range from one day to 100 days. The most expensive MS-DRGs have the longest average stays. These expensive hospital services may include open-heart surgery or lung … Read more

If you’ve never heard of ancillary services before, you’re in the right place. Learn what these are and why you should care today.

In recent years, healthcare delivery systems have been focused on providing patients as much freedom of choice when it comes to their personal healthcare. These common types also allow for efficiency, lowered costs, and ease of use. 1. Telemedicine Although telemedicine existed before the COVID-19 pandemic, it has seen monumental growth in recent years. A … Read more

In healthcare, APC stands for advanced practice clinician or ambulatory payment classification. What is an Advanced Practice Clinician (APC)? Advanced practice clinicians include advanced practice registered nurses as well as physician assistants (PAs), although generally, APC refers to nurse practitioners (NPs) & physician assistants (PAs). An APC, or APP, is a healthcare provider who has … Read more

Beginning in 1983, PPS, or prospective payment system was implemented for use by the Centers for Medicare and Medicaid Services (CMS). A prospective payment system provides reimbursement for medical services according to a specific classification system unique to the service that the patient receives. According to CMS, “CMS uses separate PPSs for reimbursement to acute … Read more

To know what an ambulatory care pharmacy is, we first need to know what ambulatory care is. Ambulatory care or ambulatory treatment is another word for any outpatient care. This is any medical care that happens outside of a hospital. According to the Agency for Healthcare Research and Quality, “these settings include medical offices and clinics, … Read more

The ultimate guide to navigating what can be a confusing topic in healthcare. Although it can sound daunting, almost everyone will have to work with a third-party payer when navigating healthcare costs. You’ve likely dealt with one without even realizing a third-party payment (TPP) is what it’s called. Third-Party Payment Definition In the healthcare world, … Read more

Have you recently heard of the term ‘healthcare surrogate’, but don’t know to whom or what it’s referring to? Perhaps you’ve been asked to become a loved one’s healthcare surrogate or have even been suggested to designate a surrogate decision-maker yourself. Either way, a healthcare surrogate is an extremely important decision, and one that we … Read more

Have you heard the term ‘FACETS’ in a healthcare setting and wondered what it is? FACETS is a core administration solution for health plans, developed by TriZetto®. It automates common healthcare administrative tasks, including claims processing, billing, care management, and network management workflow. FACETS was born out of the necessity for a solution that allowed … Read more