Get A Guide To Understanding Reimbursement For

Reimbursement describes how commercial insurance plans (or the government) pay for items or services provided by medical professionals. It can be broken down into three major components: coding, coverage and payment (see Fig. 1).

A physician receives a payment to cover all services for a patient over a specific period of time. For example, if a doctor sees 100 patients; she may be reimbursed for, $25 per patient per month. This covers all associated costs. One patient may incur $2,500 in fee-for-service treatment, while another incurs nothing.

Fee-for-service (FFS) is the most common reimbursement structure and is exactly what it sounds like: providers bill a code for every service performed, including supplies.

Health care is a service paid for by reimbursement, largely because healthcare providers and hospitals can't turn you away if you are having a true emergency, and also because the specifics of the service usually can't be determined with complete certainty in advance.

Reimbursement strategy often plays a role in what device companies ultimately decide to develop. Made up of three distinct parts - coding, coverage, and payment - reimbursement is the lifeblood of industry success.

A healthcare reimbursement plan is a benefit where employers reimburse their employees for medical expenses. This differs from traditional group health plan coverage because the employer makes a benefit allowance available instead of choosing and administering a group health insurance policy from a carrier.

What are the Methods of Hospital Reimbursement? Discount from Billed Charges. Fee-for-Service. Value-Based Reimbursement. Bundled Payments. Shared Savings.

Strategic reimbursement planning and execution involves the complex and predictive development of comprehensive reimbursement plans that speak to coding, coverage and payment initiatives to help grow your business and successfully commercialize your product.