This essay focuses on third-party payer models. criteria and draws nuanced connections between third-party payer models and reimbursement
Score of Federal and State: Government Payer Types,/ 3.76
Third-Party Payment: Reimbursement
Meets “Proficient” criteria and draws nuanced connections between third-party payer models and reimbursement
A third-party payer is, to put it simply, anyone who pays for medical services other than the patient himself. There are several types of third-party payers for healthcare services in the U.S. The most commonly seen ones are private insurance companies, like Blue Cross, and government insurance, like Medicare for the elderly or Medicaid for those with lower incomes.
All of these third-party payers will cover a portion of what the patient owes for his medical services, and each type of payer has its own set of conditions that must be met by the clinician or facility providing the services in order for it to get paid. These sets of conditions used to be much simpler than they are now, but because the presence of third-party payers has driven up costs of medical services, these conditions are changing to allow care to become more cost-effective.
Accurately evaluates third-party payer models for the impact they present on healthcare system reimbursement
Evaluates third-party payer models for the impact they present on healthcare system reimbursement but with gaps in accuracy or details;
Firstly, 0 points
Secondly, Does not evaluate for the impact they present on healthcare system reimbursement
Thidly, Score of Third-Party Payment: Reimbursement,/ 3.76
Further, Third-Party Payment: Reporting Requirements
further, 6.26 points
lastly, Meets “Proficient” criteria and demonstrates advanced knowledge of third-party payer payment systems’ reporting guidelines lastly, and requirements
Accurately analyzes reporting guidelines required by third-party payer payment systems for the opportunities and challenges facing healthcare leaders in meeting reporting requirements