Competencies:732.2.1: Reimbursement Methodologies The graduate describes and compares contemporaryhealthcare reimbursement methodologies and systems utilized in the United States.732.2.3: Voluntary Healthcare Insurance Plans and Managed Care The graduate describes keycomponents of private, commercial, and Blue Cross and Blue Shield insurance plans and evaluates howvarious insurers use coding in the billing process.732.2.4: Government-Sponsored Healthcare ProgramsIncluding Medicare and Medicaid Thegraduate evaluates and explains various government-sponsored healthcare programs and recognizes theimpact that government-sponsored healthcare programs have on the healthcare system in the UnitedStates.732.2.5: Government-Sponsored Healthcare ProgramsOther Components and Methods Thegraduate evaluates and explains components and methods of non-Medicare/non-Medicaid governmentsponsoredhealthcare programs; and recognizes the impact that government-sponsored healthcareprograms have on the healthcare system in the United States.732.2.6: Ambulatory Reimbursement Systems The graduate evaluates and explains the structuresand components of and performs payment calculations for outpatient healthcare reimbursement inhealthcare organizations.Introduction:The healthcare reimbursement systems in the United States are complex. A health informatics professionalneeds an understanding of the basic principles of the third-party payer system and the many options thatare available to citizens through government-funded healthcare programs. Private and commercialinsurance companies and BlueCross BlueShield plans offer a different menu of options to their clients. Allthird-party payers are interested in decreasing healthcare costs while improving quality and controllingaccess to unneeded services.In this task, you will examine the complexity of the healthcare reimbursement systems and begin tocompare the similarities and differences between them. To complete this task, write an essay discussingeach type of healthcare insurance plan listed, as well as the plan components, reimbursement provisions,restrictions, and the impact government regulations have on each.Requirements:Write an essay in which you do the following:A. Discuss the insurance plan components and restrictions of each of the following:1. Fee for service (indemnity) plans2. Managed care plans3. Government-sponsored health plans Medicare Medicaid State Childrens Health Insurance Program (SCHIP) Military/TRICARE Indian Health Service4. High-deductible health plans/healthcare savings accountsB. Discuss the inpatient and outpatient reimbursement process of each of the following:
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