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:Reimbursement Methodologies Revenue Cycle Claims submitted and adjusted by payor Examine different methodologies used by payors to reimburse providers. 4
Slide notes:This lecture completes the discussion of the revenue cycle by explaining claims submission. It also examines the various methodologies by which payors reimburse providers. Payment requests can be submitted 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. Health IT Workforce Curriculum Version 4.0 4