reimbursment 3-1.docx - There are numerous suppliers in the claims process They include health care providers and other entities other than providers

reimbursment 3-1.docx - There are numerous suppliers in the...

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There are numerous suppliers in the claims process. They include health care providers and other entities other than providers that provide health care services to patients. Payers include insurance companies, the government, and individuals who do not have health insurance. All these entities play a role in the claims processing. The providers provide services to patients and document these as a record for not only the health history but for billing and coding purposes. The payers pay claims or file appeals when bills are submitted. They work with hospitals and providers to arrange payments and make agreement on prices for services (Harrington, 2016). Both payers and suppliers work hand in hand to have claims be successfully reimbursed to avoid service interruptions. In the claims process there are two types institutional and professional. Institutional is any claim using the HIPPA mandated transaction institutional form UB-04. Professional claim is a professional claim using a paper claim form CMS-1500 (Harrington,2016). Ethics play a
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  • Fall '19
  • Harrington, Mechanics of Insurance and Reimbursement

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