Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Revenue Cycle of Various Health Care Enterprises
Slide content:The Business of Health Care - 1 Health Care Organizations: Receive payments from 3rd party Payment depends on: Codes entered on bill for type of service provided and diagnosis Formula determined by payor Formula is rarely transparent 5
Slide notes:As with other business entities, health care organizations must receive income to pay expenses. Managing expenses in health care organizations is similar to any other business. However, health care is unique in the way in which it receives payment. There are four features that make the business of health care different: First, a third-party payor makes the majority of payments to someone other than the patient for services provided. Second, the amount paid or reimbursed by an insurance plan depends entirely on codes entered on the bill or claim that indicate the type of service provided and the reason or diagnosis for the service or services and a formula determined by the payor. This formula for payment frequently is not transparent. 5