How does the US Reimbursement System work?
- The US healthcare reimbursement system works by paying healthcare professionals the fees incurred when their services are used. Payment is made either through the Public or Private Insurance programs.
- Three essential criteria must be met for reimbursement to take place. These are coding, coverage, and payment.
- Coding is the standardized terminology for medical terms so that definition and billing of services are uniformed
- Coverage is what service, product, or technology are within the list of what would be covered by a payer’s health plan
- Payment is the dollar amount for the service received. The payer decides what payment plan he/she will use for such service and then the claim is processed for reimbursement to proceed
- The presentation below shows a summary of the US Healthcare Reimbursement System