3-1 Discussion: Claims Processing and Reimbursement

3-1 Discussion: Claims Processing and Reimbursement
Name
Institution
Date
health claims processing and reimbursement
In your post, compare and contrast various payers and suppliers and the claims filing process. How important are ethics with claims processing? Explain how ethics can impact payer mix and reimbursement. In response to your peers, support their position with additional ideas and concepts from the module’s readings. Offer a potential problem that could arise when dealing with claims filing
The payers involved are the government agencies and the private or commercial payers, and they facilitate payment of services through various programs. Medicare and Medicaid are the largest players in health insurance. Under Medicare there are different plans in parts A, B, C and D, and part A focuses on employment, insurance covers for medications, supplies and services covered by the inpatient or outpatient health care organizations. Part C focuses on health maintenance organizations (HMOs), local preferred provider organizations (PPOs) and the provider sponsored organizations (PSOs). Part D insurance covers access to the low cost prescriptions (Harrington, 2016).
The suppliers refer to the physicians, practitioners or entities other than the providers who furnish healthcare services under the Medicare program (Harrington, 2016). The providers must meet the Medicare requirements and the applicable conditions to qualify. The providers include the Acute Care Hospital, Critical Access Hospital, Skilled Nursing Facility, Inpatient Rehab Facility, Outpatient Rehab Facility, Home Health Agency, Hospice Agency, Home Infusion and Durable Medical Equipment (Harrington, 2016).
Ethics are important as accurate information is communicated to the patients, payers and providers. The med...