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:Remittance Reimbursement received Reduced amount due to coinsurance, copayments, or contract Challenges Non-payment by payor Incorrect reimbursement Final settlement with patient coinsurance 8
Slide notes:After processing by an examiner or adjuster at the payor, reimbursement is sent to the provider. In most cases, reimbursement is less than the amount billed, due to co-payments, co-insurance, or contractual arrangements. While most providers expect reductions in the amount billed, challenges occur when payment is less than anticipated, since this results in lower than expected revenue. There are few industries or other types of insurance where this occurs. After receiving payment from the payor, a final bill is prepared for settlement with the patient. In most cases, this represents co-insurance amounts. 8