Prior to 2001, cms was known as the health care financing administration (hcfa) Despite the copyrighted nature of the cpt code sets, the use of the code is mandated by almost all health insurance payment and information systems, including the centers for medicare and medicaid services (cms), and the data for the code sets appears in the federal register. Hcpcs was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health.
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Case mix groups are used as the basis for the health insurance prospective payment system (hipps) rate codes used by medicare in its prospective payment systems
[1] case mix groups are designed to aggregate acute care inpatients that are similar clinically and in terms of resource use.
Medical billing, a payment process in the united states healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed [1] this bill is called a claim
