Controversies in Billing for Clinical Services - American Society of ...

Methods for Reimbursement
Third Party Payers
– Can be fee-for fee for-service service
– Can be capitation / managed care
– Each payer may be different
Credential providers
– Different requirements for credentialing providers
– Different providers recognized
– Different CPT codes may be allowed
– Different reimbursement rates they will pay out
Prior authorization
– Find out which CPT code to use
– Authorized to provide a service per patient
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