Medical Reimbursement

Reimbursement from a medical perspective refers to a repayment or compensation arrangement made to healthcare providers who incurred cost while offering medical services. The reimbursement concept is common in advanced healthcare systems such as exist in the United States. According to Harrington (2015)¹, reimbursement is synonymous with managed care payment where a third party such as an employer or insurance company pays for healthcare services after an employee or insured beneficiary accesses such services. 

Perhaps the best way to understand how reimbursement policy works is by referring to how employees in a company are refunded for personal finances after a business trip. The usual way for this is to submit a request to the company’s accountant along with receipts as proof of money spent on a business trip. Similarly, the government and insurance companies ensure that healthcare providers including doctors, physicians and hospitals are reimbursed for costs incurred while offering medical services to a patient. At this point, one must understand that it is the healthcare providers who are reimbursed and not the patients.

For medical students and researchers with an interest in writing an essay or doing research on reimbursement, understanding the procedures for medical reimbursement is of great importance. For example, an essay or research paper on medical reimbursement must have details of how the compensation is claimed, as well as the documentation guidelines.  Understanding the relationship between the Centers for Medicare and Medicaid Services (CMS) and medical reimbursement is critical. Such information can be read on the Centers for Medicare and Medicaid Services website (CMS n.d.)². Terms like Fee-for-Service (FSS) and Value-Based Care are common in the reimbursement models as applied in the healthcare system and need to be understood.

Several essays and research papers articulate the changing healthcare environment. In this regard, the changing insurance products and markets, and the increasing size of the uninsured population, are affecting the operations of the medical reimbursement policy.  In addition, the increased promotion of wellness and nutrition programs are now acting as a complimentary concept or an alternative to medical reimbursement. The use of technology and especially implantable devices are a major source of hospital-acquired infections and illnesses and as such have made reimbursement a costly concept to employers and insurers.

References

1.  Harrington KH, 2015, Health care finance and the mechanics of insurance and reimbursement, Jones & Bartlett Publishers, Burlington.

2.  Centers for Medicare & Medicaid Services n.d., CMS covers 100 million people. [Online]. Available at: https://www.cms.gov/ [Accessed 20 June 2016]

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