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Reimbursement is the act of compensating someone for an out-of-pocket expense by giving them an amount of money equal to what was spent. [1]Companies, governments and nonprofit organizations may compensate their employees or officers for necessary and reasonable expenses; under US [2] [3] law, these expenses may be deducted from taxes by the organization and treated as untaxed income for the ...
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed.
A Health Reimbursement Arrangement, also known as a Health Reimbursement Account (HRA), [1] is a type of US employer-funded health benefit plan that reimburses employees for out-of-pocket medical expenses and, in limited cases, to pay for health insurance plan premiums.
In the United States, ERISA reimbursement refers to the efforts of an ERISA Plan administrator (an insurer) to obtain repayment from an insured person who had previously received payments for personal injury medical bills. [1] [2] When an insurer pays an injury claim to someone, the insurer can seize cash settlements from whoever caused the ...
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [1]In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
A co-payment must be paid each time a particular service is obtained. Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that an insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co ...
For example, with a deductible of 10% with a minimum of $1,500 and a maximum of $5,000, a claim of $25,000 would incur a deductible of $2,500 (i.e. 10% of the loss), and the resulting payment would be $22,500. A claim below $15,000 would incur the minimum deductible of $1,500, and a claim above $50,000 would incur the maximum deductible of $5,000.
Retrospective payment is sometimes called "virtual bundling." [56] Approach to risk adjustment: bundled payments often use a risk adjustment approach to modify the price of the bundle to reflect the severity of the patient's condition. Payment methods vary on the basis of which factors are used to determine the risk adjustment (such a patient ...