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Home / Essays / Reimbursement: Fundamentals of Reimbursement in Healthcare

Reimbursement: Fundamentals of Reimbursement in Healthcare

Rate of reimbursement %= Reimbursement (payment)/ Fee × 100%

USA Insurance Company

Sims Effie: Rate of Reimbursement= 70/125×100%= 56%

Jones Thomas: Rate of reimbursement= 57/75×100%= 76%

Asberry Alex: Rate of reimbursement= 69/90×100%= 76.67%

Brooks Glen: Rate of reimbursement= 83/128×100%=64.84%

Brown Jameson: Rate of reimbursement=50/85×100%=58.82%

Owens Tommie: Rate of reimbursement=70/100×100%=70%

Presley Elvix: Rate of reimbursement=45/92×100%=48.91%

Switty Conway: Rate of reimbursement=50/88×100%=56.82%

Wilson Kevin: Rate of reimbursement=165/225×100%=73.33%

ABC Insurance

Yeager Rebecca: Rate of reimbursement=90/120×100%=75%

Conway Stephanie: Rate of reimbursement=49/72×100%=68.05%

Lackey Timothy: Rate of reimbursement=64/95×100%=67.37%

Floyd Connie: Rate of reimbursement=76/121×100%=62.81%

Wilson Jackson: Rate of reimbursement=35/80×100%=43.75%

Norton Celia: Rate of reimbursement=90/120×100%=75%

Powers Matthew: Rate of reimbursement=56/98×100%=57.14%

Nelson Carol: Rate of reimbursement=35/78×100%=44.87%

Sanderson Rose: Rate of reimbursement=145/205×100%=70.73%

Best Insurance Agency

Shows Robert: Rate of reimbursement=50/80×100%=62.50%

Jones Teresa: Rate of reimbursement=94/112×100%=83.93%

Trane Caroline: Rate of reimbursement=49/75×100%=65.33%

Nesbitt Richard: Rate of reimbursement=85/130×100%=65.38%

Smith Kyle: Rate of reimbursement=30/65×100%=46.15%

Jacobs Jasmine: Rate of reimbursement=55/100×100%=55%

Trinity Penelope: Rate of reimbursement=25/75×100%=33.33%

New Deloris: Rate of reimbursement=35/78×100%=44.87%

Wilson Brother: Rate of reimbursement=125/195×100%=64.10%

USA Insurance Co, Inc. Radiology Dept

Sims Effie: Rate of reimbursement=90/180×100%=50%

Jones Thomas: Rate of reimbursement=55/100×100%=55%

Asberry Alex: Rate of reimbursement=95/175×100%=54.29%

Brooks Glen: Rate of reimbursement=45/130×100%=34.62%

Brown Jameson: Rate of reimbursement=100/165×100%=60.61%

Owens Tommie: Rate of reimbursement=115/195×100%=58.97%

Presley Elvix: Rate of reimbursement=85/175×100%=48.57%

Switty Conway: Rate of reimbursement=89/218×100%=40.83%

Wilson Kevin: Rate of reimbursement=75/145×100%=51.72%

Patients’ details

Patient

Radiology Dept

Fee $

Radiology Dept

Payment $

Radiology Dept

Rate of reimbursement %

Medical Centre

Fee $

Medical Centre

Payment $

Medical Centre

Rate of reimbursement %

Sims Effie

$180

$90

50%

$125

$70

56%

Jones Thomas

100

55

55

75

57

76

Asberry Alex

175

95

54.29

90

69

76.67

Brooks Glen

130

45

34.62

128

83

64.84

Brown Jameson

165

100

60.61

85

50

58.82

Owens Tommie

195

115

58.97

100

70

70

Presley Elvix

175

85

48.57

92

45

48.91

Switty Conway

218

89

40.83

88

50

56.82

Wilson Kevin

145

75

51.72

225

165

73.33

Yeager Rebecca


 


 


 

120

90

75

Conway Stephanie


 


 


 

72

49

68.05

Lackey Timothy


 


 


 

95

64

67.37

Floyd Connie


 


 


 

121

76

62.81

Wilson Jackson


 


 


 

80

35

43.75

Norton Celia


 


 


 

120

90

75

Powers Matthew


 


 


 

98

56

57.14

Nelson Carol


 


 


 

78

35

44.87

Sanderson Rose


 


 


 

205

145

70.73

Shows Robert


 


 


 

80

50

62.5

Jones Teresa


 


 


 

112

94

83.93

Trane Caroline


 


 


 

75

49

65.33

Nesbitt Richard


 


 


 

130

85

65.38

Smith Kyle


 


 


 

65

30

46.15

Jacobs Jasmine


 


 


 

100

55

55

Trinity Penelope


 


 


 

75

25

33.33

New Deloris


 


 


 

78

35

44.87

Wilson Brother


 


 


 

195

125

64.1

Payments by vendors

Looking at the rates of reimbursement for the various vendors, it would be correct to state that Best Insurance Agency had the highest payment rate basing on the patient Jones Teresa who had the highest fee reimbursement rate at 83.93%. For the radiology services, the patient Brown Jameson had the highest rate of reimbursement at 60.61% which was due to USA Insurance Co. Inc.

It is necessary for patients to know the rate of reimbursement offered by their insurance companies as generally these rates are normally pegged on the premiums they pay. The higher the amounts of premiums paid by the insured the higher the rate of reimbursement. The lack of knowledge concerning these rates usually puts clients at a disadvantage in that the insurers can easily exploit them or even manipulate facts to their disadvantage, hence making them to lose out.

A healthcare record can be transformed into coded data by manually extracting the data from the record and then inserting it into an automated tool before they are then analyzed and organized into coded data. Data extraction from health records involves the use of metrics among other options. Coded data is important in such vital areas as pay-for-performance systems and to do with medical centre biosurveillance among other important healthcare infrastructure.