Case mix measures the types and complexity of patients treated in a healthcare facility, determining the required resources and influencing reimbursement rates.

A case-mix group (CMG) is a classification system used to group patients with similar characteristics and conditions together.

The case mix index (CMI) in healthcare is a metric that represents the relative value assigned to a group of patients based on their diagnosis-related groups within a medical care setting.

Discover how case-rate methodology works, its benefits, and examples. Learn how this fixed-payment model simplifies billing and promotes cost efficiency in healthcare.

Discover how charge descriptions enhance billing accuracy and transparency. Learn their importance in claims processing and see examples in emergency care and dental cleaning.

The Charge Description Master (CDM) is a vital resource in healthcare, containing a comprehensive list of services and supplies along with their corresponding charges.

A charge status indicator is a code used in healthcare to uniquely identify a charge's status (pending, denied, or billed).

The children's health insurance program (CHIP) is a federal initiative in the United States that offers affordable or accessible health coverage to eligible children from families with limited income.

A clinical denial occurs when an insurance payer rejects a healthcare claim because of a mismatch between the clinical documentation and the services billed.

Understand clinical validation denial, its impact on claims, and how to avoid it. Explore examples and strategies for ensuring accurate and compliant documentation.

The CMS Hierarchical Condition Categories (CMS-HCC) model is a risk adjustment methodology.

It is used by the Centers for Medicare and Medicaid Services (CMS) to adjust payments based on the health conditions of Medicare beneficiaries.

It essentially helps predict future healthcare costs by grouping diagnoses into categories that reflect their severity.

A coding compliance plan is a documented strategy that outlines procedures to ensure accurate and compliant medical coding practices within healthcare organizations.

Coding management refers to overseeing and optimizing the accurate assignment of medical codes to healthcare services and procedures.

Community rating is referred to as a healthcare pricing model in which insurance premiums are calculated based on the average cost of healthcare services.

Contractual allowance refers to the difference between the standard charges for healthcare services and the amount contractually agreed upon with payers or insurance companies.

Learn how the Conversion Factor (CF) translates Relative Value Units (RVUs) into actual payment rates in healthcare. Discover its components, calculation formula, and real-world examples for accurate revenue cycle management.

Coordination of benefits (COB) is a process used by health insurance plans to determine the order in which multiple insurance plans will pay for a claim.

Explore cost reports in healthcare, their impact on reimbursements, and types like Medicare, skilled nursing, and clinic cost reports. Learn how they guide financial transparency.

Explore how cost-of-living adjustments (COLA) impact healthcare salaries, Social Security, and Medicare. Learn about its purpose, examples, and regulatory guidelines.

A covered condition in healthcare refers to the medical conditions that are eligible for reimbursement by the healthcare payers.

A covered service can be defined as a medical procedure, treatment, or healthcare service that qualifies for reimbursement under a patient's insurance plan or government program.