healthcare

Health care organizations that participate in all of the health care plans are reimbursed according to the policy or contract of each health care plan. As discussed in Phase 1 of this course, the following insurance plans each have specific guidelines, rules, and regulations that govern the contracts, coverage, and payment methods made to health care facilities.

Each of the five insurance plans (Medicare, Medicaid, TRICARE, worker’s compensation, and commercial insurances) are governed by either federal, state, or local agencies, or they are administered by private organizations and businesses.

List the five insurance plans, identify who governs each plan, and describe what type of reimbursement or payment system each plan uses. Focus your discussion on the following questions:

• Why is it important to stay current with the guidelines for each?
• Should mandatory training be provided for insurance billing and coding? Explain your answer.