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Third-Party Payers

Using APA Style Describe the major third-party payers and the characteristics of managed care organizations on a 500 words. In your descriptions, consider how coding impacts reimbursement. On two different paragraph give your opinion to Kent Acheson and Ryan Stuck. A complete assignment needs no more than two pages.

Kent Acheson

 The healthcare industry is unique in the business world. Unlike normal businesses that provide services or products to consumers, the healthcare industry varies greatly in its structure and intent. Healthcare organizations are specialized in the services they provide. Consumers find it difficult to judge the quality of competing providers within the healthcare industry. Additionally, referrals for healthcare services often come from a licensed professional, such as a physician, rather than another consumer.

As a future member of the healthcare industry, it is important that you have a clear understanding of the methods in which this industry receives payment. The healthcare industry is also unique in the manner in which it receives payment for services rendered. Reimbursement from third-party payers is the most common form of payment received by healthcare organizations. Unit two will introduce you to basic insurance concepts, third-party payers, managed care organizations, and medical coding.

Ryan Stuck

Third-party payers are those insurance carriers including public, private, managed care and preferred provider networks that reimburse fully or partially the cost of healthcare provider services. The healthcare providers are hospitals, physicians, dietitians, pharmacists, nurse practitioners and all those caring for the patient. Third-party payers often do not pay 100 percent of a patient's bill. Deductibles are the portion of the bill the patient pays before the insurance company becomes responsible. Many of today's high deductible plans may require the insured to pay up to $5,000 out of pocket before the insurance company pays a cent.

Coding accuracy is vital to patients and providers being covered appropriately for care that they received or provided. If mistakes are made this requires hours of time to fix. It is also important for the providers to make sure the patient is approved so procedures before providing the care.

 References

Tavaglione, N., & Hurst, S. A. (2012). Why Physicians Ought to Lie for Their Patients. American Journal of Bioethics, 12(3), 4–12. https://doi.org/10.1080/15265161.2011.652797