Provider reimbursement describes the payments that are made from the insurance organizations for healthcare services to qualified hospitals or medical experts. The amount of money given for reimbursement depends on the policies governing the insurance and the medical providers along the claims advanced by the medical experts. The approval process of the reimbursement depends on the terms and regulations associated with the claim. Provider reimbursement can be provided by private or governmental insurance providers (Anne & Layman, 2014). Reimbursement is very crucial in healthcare financing because it assist the health care consumers to have financing for the services received in the health facilities. Another benefit is the patients do not have to engage their insurance provider in claiming for the payments, but the accounting officer in the health facilities is in charge of the claims.
Financing of health care services is one of the critical constructs of health care service delivery (Anne & Layman, 2009). The methods of financing health care entail the technique that is used to clear the hospital and healthcare facility bills. There are various methods that are used and they include Medicare Medicaid by the state, Military of Veteran affairs, Indian Health Services, Private Indemnity services, Managed care, private Pay, Subsidized Affordable Care Act Plans, Point of Service, private health insurance, external aid (World Bank, 2011).
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Medicaid: The Medicaid and Medicare for the state is the most common payment method in the United States. This is a plan that is fronted by the government to cover all citizens of all social orientations to facilitate the acquisition of high-quality health services.
Military of veteran Affairs: This is an association the assist in fixing the financial issues associated with the military officers and the veterans.
Indian health services: It provides federal health service financing to the Alaska Natives and the American Indians.
Private Indemnity services: these are insurance agencies associated with the provision of solutions to risks through compensation schemes that are well structured
Managed Care: This includes getting financial cover for health services from organizations that are in contact with the government.
Private: private pay entails the payments that are made by individuals from the health services provide to them from the facilities
Subsidized Affordable Care Act Plans: these are health insurance subsidies and premiums that are created by the Affordable Care Act to benefit people with lower incomes in covering their health needs
Point of Service: This is a service plan that gives the consumers numerous choices that includes the combination of PPOs, HMOs and other traditional plans for healthcare (Rank, 2014).
Private health insurance: The private insurance entails the plans that are taken by individuals to cover their health needs. These plans are customized to the needs of the client, but they are equally expensive.
External Aid: This entails the external organizations and agencies that give aid to the underprivileged people who cannot raise their medical fee.
There are various types of provider reimbursement. Pay-for-service is one of the most common provider reimbursement types. In this type, the providers receive payment for the service that is given to the consumer (Anne & Layman, 2014). Each of the fees charged by the service providers is paid by the insurer for all the covered services. Self-pay is a fee-for-service plan because the guarantors or the patients pay for all the services received. The patients make the payments and then they seek reimbursement from their insurance companies. In the Traditional Retrospective Payments mode of reimbursement, the payment is made after service delivery. The payers reimburse the funds for the services rendered (Anne & Layman, 2014).
The fee-for-service method is the most beneficial to the health care consumers. This is because the plan provides the required level of insurance to the patients, and all the charges are settled in good time without delays (Anne & Layman, 2014). Unlike in self-pay where an individual may experience financial problems and procedural follow-ups to the insurance company, Fee-for-service plan claims are made by a health care provider.
