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Reimbursement requirements for billing purposes in the USA healthcare system - Essay Example

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Reimbursement requirements for billing purposes in the USA healthcare system Name: Institution: Introduction Insurance refers to a means of indemnity against a future occurrence of uncertain events. People ascribe to different insurance services in order to cushion themselves from different forms of uncertainties…
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Reimbursement requirements for billing purposes in the USA healthcare system
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Download file to see previous pages There are two types of insurance service providers; private and government. Private insurance is a form of business just as any other and therefore exist primarily to make profit. They therefore develop service bouquets that protect their primary interests of profitability. Government insurers on the other hand obtain their funding from the taxpayers and therefore operate with the sole objective of providing affordable medical insurance to the appropriate citizens. Government therefore provides insurance services to its employees known as civil servants and the poor in the society most of whom cannot afford the cost of private insurance. In both cases, the insured remit a monthly contribution to the service provider for the insurance coverage. On those considered the poor by the government, they remit a small amount of money set by the government, which the government supplements with money from the treasury. This way, everyone affords high quality medical services. Medical insurance services differ in terms of the cover specifications. A feature more prevalent in private insurance government insurers provides uniform services to those it considers unable to afford private services. However, it allows the civil servants to choose from the different service bouquets it outlines on its coverage. The different cover specifications vary in the monthly or annual remittance. The private insurers have dynamic medical services ensuring that they cover any form of medical condition; the more expensive the service is the more comprehensive its specifications become. Additionally, the quality of the services differs depending on both the service providers and the type of service package. Private insurers just as explained are business entities; they therefore survive based on the nature of their interaction with their customer base. Such service providers therefore offer quality services as a marketing strategy. With a medical insurance cover, one is assured of high quality medical services in case of a condition. However, the insurance service providers regulate the amount of money that one receives for the coverage depending on the service package. Both thee government and the private insurers have a clear demarcation for every service type therefore offer financial coverage up to the level that the service type allows (Green & Rowell, 2013). The government sets the minimal insurance services that everyone in the country should have in a bid to ensure that everyone in the country lives a high quality life. Among the most basic coverage, include accidents and recurrent diseases such as tuberculosis among others. By protecting the citizens from such diseases as cancer, among other recurrent diseases, the government ensures that everyone lives a higher quality and longer lives. The medical insurance services cover both inpatient and outpatient medical services depending on the nature of the insurance cover. The service provider explains the types of services included in the service specification thereby allowing for financial remittance accordingly. The insurance service providers deal with the medical institutions often eliminating the customer in their relations. In this case, after accessing medical services, the medical service provider consults the insurer with the patient details. The insurer receives the claim and ...Download file to see next pagesRead More
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