Reimbursement Job Aid: Reimbursement Methods
Directions:
Imagine that you work as a coder at University Hospital. Your coding manager asks you to make a job aid to help all new coders understand the different reimbursement methodology based on the patient setting where the care was provided. Specifically, your coding manager requests that new coders use this job aid as a guide to better understand why the code sets assigned for each patient type are used with respect to reimbursement. With this job aid, the coders will be able to reference the care settings and associated reimbursement methodology.
Follow the steps below to complete this assignment:
1. Use research attached on reimbursement methodologies. This source will serve as a reference in your job aid. Review the rest of the directions for this assignment before conducting your research so you know what specific information your source needs to contain.
2. Articulate explanations of the four care settings:
a. Inpatient hospital
b. Outpatient hospital
c. Physician office
d. Long-term care
3. Include the following information for each care setting:
a. What reimbursement methodology is used in the care setting
b. An explanation or description of that methodology
c. Which classification system(s) is/are used in the care setting
d. Any specific rules or processes that need to be considered when applying the reimbursement methodology for the care setting
e. An example of when the payment system is used
4. Determine a format that works best to share this information in the form of a job aid. Remember, a job aid should be a brief, well-organized document that provides easy access to reference information. Include the above information in your job aid
does not neccassary have to be essay format to complete assignment
Title
Your name
Subject and Section
Professor's name
Date
Reimbursement Job Aid: Reimbursement Methods
Inpatient
The fee-of-service method is appropriate for outpatient care. It allows the physician to gain revenue based on patients' volume or insurance clients in a day (Axene, 2019). Its subcategory, the fee schedule, may be used in the inpatient care, where the third-party payor shall reimburse the money to the provider based on the services given (Castro & Forrestal, 2013). An example of this is paying all the insurance company's expenses after the patient has been discharged.
Outpatient
The fee-of-service method is appropriate for outpatient care. It allows the physician to gain revenue based on patients' volume or insurance clients in a day (Axene, 2019). Mainly, the self-pay subcategory can be utilized to oblige each patient to pay for the specific services received. The guarantors compensate the health providers for each accomplished treatment. Then, they shall reimburse their expenses from the insurance company (Castro & Forrestal, 2013). An example of this is when a patient has undergone a transvaginal ultrasound. The amount paid by the patient shall be reimbursed by the insurance comp...