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Medical billing is a payment practice within the U.S. healthcare system that involves coding, submitting, and processing healthcare claims for reimbursement. Learn about the medical billing process, the history of medical billing, and the certification and software options for medical billers.
ZPIC is a US entity that fights fraud, waste and abuse in Medicare. It replaced PSC in 2003 and covers seven zones for processing claims.
A third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity. Learn about the roles and functions of TPAs in health care, retirement plans, and commercial general liability.
CMS is a U.S. agency that administers Medicare, Medicaid, CHIP, and other health insurance standards and quality measures. It was established in 2001 and has over 6,000 employees in various locations.
Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities. It covers hospital, outpatient, prescription drug, and private plan services, and is administered by the Centers for Medicare and Medicaid Services.
Pharmacy benefit management (PBM) is a third-party administrator of prescription drug programs for various health plans in the US. PBMs negotiate prices, rebates, and formularies with pharmaceutical companies and pharmacies, and have faced criticism for unfair practices and lack of transparency.
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