The process by which healthcare providers receive payment for services rendered to patients, typically from insurance companies, government programs (such as Medicare or Medicaid), or directly from patients themselves.
A payment model where healthcare providers are reimbursed based on the quantity of services provided. Each service is billed separately, and payment is made for each service rendered.
A payment model where healthcare providers receive a fixed amount per patient enrolled in a specific time period, regardless of the services provided. This model incentivizes providers to deliver efficient care and manage costs.
A system used to classify hospital cases into groups based on diagnoses, treatments, and procedures. Hospitals are reimbursed a fixed amount for each patient within a specific DRG, regardless of the actual costs incurred.
A payment model that ties reimbursement to the quality and efficiency of care provided rather than the quantity of services rendered. This model aims to improve patient outcomes and reduce overall healthcare costs.
The process of assigning alphanumeric codes to describe medical diagnoses, procedures, and services. These codes are used for billing purposes and to communicate information about patient care.
Federal legislation that establishes standards for the privacy and security of protected health information (PHI). Compliance with HIPAA regulations is required for healthcare providers, insurers, and other entities handling PHI.
A federal health insurance program primarily for individuals aged 65 and older, as well as younger people with certain disabilities or medical conditions. Medicare reimburses healthcare providers for covered services according to various payment systems.
A joint federal and state program that provides health insurance to low-income individuals and families. Medicaid reimbursement rates vary by state and are typically lower than Medicare and private insurance rates.
Expenses that individuals are required to pay directly for healthcare services, such as deductibles, copayments, and coinsurance, which are not covered by insurance or other reimbursement mechanisms.