Third Party PayerMedical Insurance and BillingThird Party Pa, Lecture notes of Accounting

Download Third Party PayerMedical Insurance and BillingThird Party Pa and more Lecture notes Accounting in PDF only on Docsity! Third Party Payer Medical Insurance and Billing Third Party Payers Third party payers are defined as an organization that pays healthcare billing claims on insured’s behalf (Third Party Payer, 2020). Some examples of third party payers include governmental agencies (Medicare,Medicaid, &Tricare), Insurance companies, Managed care (Health Maintenance Organizations, Preferred Provider Organization, & Point of Service), and employers. Third party payers may be private or public and example would be the Medicaid it is a public third party payer. They all have a few things in common. They do not pay 100 percent of a patients total bill. They require the patient to pay a deductible before the insurance starts to pay for the services provided. All companies reimburse providers directly. Managed care plans have contracts with healthcare providers and medical facilities to provide care at reduced cost. Health Maintenance Organizations or HMO’s pay for care only within their network. Preferred Provider Organization or PPO’s pay more out with in network providers, but will pay a percentage of out of network cost. Point of service or POS plans are a cross between HMO and PPO. A primary care provider would have to be chosen, but like PPO out of network providers may be used with a percentage of cost paid for. Medicare is a governmental program for people who are 65 and up, younger people with disabilities and people with end stage renal disease. It is broken down in three different part. Part A which covers inpatient stays, nursing facilities, hospice care, and home health. Part B is the medical coverage, it covers doctor visits, outpatient care and medical supplies. Part D covers prescription cost including shots and vaccines.Medicare recipients depending on which plan option is chosen would have to pay a deductible at the beginning of the year and coinsurance would have to be paid which is 20 percent of medicare approved services. Medicaid is a governmental insurance as well, but is funded by the government and state. Medicaid is for low income families, and needy people, such as children, elderly, disabled, blind, and any other person with low income. The state and government pay a percentage towards the program. Then, the state make their own provider rates for the program, but with federal