Fundamentals of Reimbursement in Healthcare

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Task Type: Individual Project   Deliverable Length: 4 paragraphs    
Points Possible: 100   Due Date: 2/22/2015 11:59:59 PM  CT [removed]    

Weekly tasks or assignments (Individual or Group Projects) will be due by Monday and late submissions will be assigned a late penalty in accordance with the late penalty policy found in the syllabus. NOTE: All submission posting times are based on midnight Central Time.

This example health care company provides an integrated delivery system (IDS) that offers a variety of medical services to a diverse population. In your role at the hospital, you must communicate specific information to patients about their insurance coverage so that your facility will be correctly reimbursed.

The example health care company Web site provides different policies on all five health care insurance plans (e.g., Medicare, Medicaid, TRICARE, worker’s compensation, and commercial insurance).

Complete the following as you would respond to patients:

  • Explain the billing process.
  • Explain what provider-based billing is and what the patient can expect.
  • Explain how your facility handles specific billing and insurance questions about services or procedures that do not support medical necessity (and may not be paid by a patient’s insurance).
  • Explain to the patient what the term, out-of-pocket means and how it could affect his or her bill.

Note: Write a paragraph for each explanation.

Reference

HealthEast Care System. (n.d.). Retrieved from http://www.healtheast.org/

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