Reference no: EM133550878

Assignment:

In this discussion, we are talking about contract allowable and payment systems. Contract allowable is expenses in a contract that is billed to the patient.

The contract allowable has a big impact on the reimbursement to the provider. The max a provider will be reimbursed for services by an insurance company is determined by the contract allowable.

A co-pay is the set amount that is paid for each visit. A co-pay is charged when you are using an in-network provider.

Co-Pay- For example:

Your health insurance plan's allowable cost for a doctor's office visit is $100. Your copayment for a doctor's visit is $20.

• If you've paid your deductible: You pay $20, usually at the time of the visit.
• If you haven't met your deductible: You pay $100, the full allowable amount for the visit.

Coinsurance is the percentage the insurance and patient will have to pay after the deductible has been met. Knowing the difference between the two is important when documenting important information in regard to the patient and when submitting claims when billing and coding. It gives you a better understanding of how to bill a patient for services that were utilized.

Coinsurance- For example:

If your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%.

• If you've paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.
• If you haven't met your deductible: You pay the full allowed amount, $100.

3 examples of payment systems is:

• Fee for service: healthcare providers are paid for each service that is provided to patients.
• Discounted fee for service: providers provide and agree on a discounted rate for fees for service patients.
• Capitation: healthcare providers are paid based on how many patients there are.