Examine the basic methodologies via which both health care organizations and health care providers are paid for the goods and services they provide.

Health Insurance, Managed Care and Reimbursement Methodologies

We examine the basic methodologies via which both health care organizations and health care providers are paid for the goods and services they provide. On the institutional side, the main source of revenue for most healthcare organizations is from employer sponsored health insurance and government payers .

One would think that each insurance carrier and government health care payment system would follow the same basic methodologies. In reality, there are some areas of overlap, but there are many areas of difference as well.

This creates a requirement within the hospital setting to maintain oversight on each patient record to ensure the requirements for reimbursement are met so the organization can be properly reimbursed. However, regardless of payer, only a limited number of payment methods are currently used to reimburse for healthcare services.