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 Billing Process of Various Health Care Enterprises
Slide content:Financing Health Care, Part 2 Summary Revenue cycle Unique process Charge capture Services & diagnosis Claims coded Claim submitted and adjusted by payor Reimbursement methods Fee-for service Episode-of-care 21
Slide notes:This concludes lecture b of Financing Health Care, Part 2. In summary, the revenue cycle for health care organizations is a unique process that requires submission of medical bills or claims describing the services provided. During the preparation of claims, information about the type of medical service, the diagnosis associated with the service, and the fee for the service is gathered and coded into a claim using standardized codes. This data, along with identifying information about the patient and organization, is submitted for payment to an insurance payor either on paper or electronically. Payors enter into contracts with organizations and providers to manage the amounts reimbursed for health care services. Payors review and adjust submitted claims and pay the balance to the provider. The methodology used to adjust the claim involves either a fee-for-service approach or episode-of-care method, which is a function of the provider-payor contract. 21