Understanding the role that coding information plays in health care organizations for claim generation is crucial. The process begins with the collection of information about the patient, the services provided, and the data from the encounter (including medical documentation and charge capture).

List the steps involved in that process, and write a brief explanation for each step.

Note: Be sure to include a description of the chargemaster or charge description master (CDM) and the revenue cycle management process.

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Introduction:

The healthcare reimbursement systems in the United States are complex. A health informatics professional needs an understanding of the basic principles of the third-party payer system and the many options that are available to citizens through government-funded healthcare programs. Private and commercial insurance companies and BlueCross BlueShield plans offer a different menu of options to their clients. All third-party payers are interested in decreasing healthcare costs while improving quality and controlling access to unneeded services.

In this task, you will examine the complexity of the healthcare reimbursement systems and begin to compare the similarities and differences between them. To complete this task, write an essay discussing each type of healthcare insurance plan listed, as well as the plan components, reimbursement provisions, restrictions, and the impact government regulations have on each.

Requirements:

Write an essay in which you do the following:

A. Discuss the insurance plan components and restrictions of each of the following:
1. Fee for service (indemnity) plans
2. Managed care plans
3. Government-sponsored health plans
• Medicare
• Medicaid
• State Children’s Health Insurance Program (SCHIP)
• Military/TRICARE
• Indian Health Service
4. High-deductible health plans/healthcare savings accounts

B. Discuss the inpatient and outpatient reimbursement process of each of the following:
1. Fee for service (indemnity) plans
2. Managed care plans
3. Government-sponsored health plans
• Medicare
• Medicaid
• State Children’s Health Insurance Program (SCHIP)
• Military/TRICARE
• Indian Health Service
4. High-deductible health plans/healthcare savings accounts

C. When you use sources, include all in-text citations and references in APA format.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.