Medical Billing Manual
Health insurance refers to the contractual agreement that requires one to pay premiums covering a portion of healthcare costs like medical bills, drugs, surgical procedures, and dental treatment expenses, among others incurred by the insured. Accordingly, patients who have fully paid the premiums to their health insurance companies can either bill their insurers or pay the healthcare expenses incurred from illness or injury and wait for the insurer to reimburse their funds (Green, 2018). Essentially, there are various health insurance plans, which include Hospital indemnity policies, Free-for-service plans, health savings accounts, and Government health insurance. Insight into each type of insurance plan and the primary requirements will help determine the type of health insurance individuals subscribe to.
Free for Service Health Insurance
Under this health insurance plan, doctors and other healthcare service providers are paid for their services based on the number of services they provide or the procedures completed. Notably, their efforts in offering care services to the patients are rewarded by receiving funds from the insurance companies for every test or procedure completed whenever a patient visits a healthcare facility (Green, 2018). It is an incentive for doctors and other care providers to provide more treatments to their patients depending on the quantity of care or the patient’s outcome. Notably, one of the striking advantages of this plan is that it rewards physicians for the quantity of healthcare services provided regardless of the outcome. The free-for-service insurance plan requires patients with active insurance plans for the physicians to bill the expense to the insurers.
Hospital Indemnity Policies
A hospital indemnity policy is a plan that is meant to pay the costs of hospital admissions and other healthcare expenses like deductibles. Other insurance plans do not cover medical copays and regular expenses, food, rent, and utilities. The plan commonly covers patients admitted to intensive care units or who spend time in the hospital wards treating sicknesses related to injuries. Supplementing the existing health insurance coverage by covering the expenses for hospital stays cushions the patients from high bills, making care services affordable (Berchick, Hood, & Barnett, 2019). The hospital indemnity insurance issues the patients cash payments to pay for the extra expenses that arise while staying in the hospital based on the number of hospitalizations. The requirement for the hospital indemnity plans is a monthly payment of premiums for the indemnity insurance plan. The policy commonly covers surgeries, intensive cases, and critical care hospitalizations. However, those who pay for higher premiums have wider coverage, like outpatient surgery, emergency room visits, and ambulance services.
Health Savings Accounts
Health savings accounts (HSAs) are similar to normal savings accounts, but the saved funds are only used to cover healthcare expenses. It is an individual who has control over how the saved funds will be used to cover unforeseen healthcare expenses. The plan is simple and can be used by both high-, middle- and low-income earners, and the funds saved are not subjected to any form of tax (Rowell & Green, 2002). The only requirement for the health savings accounts coverage plan is a high-deductible plan that is essential in controlling healthcare costs. Employers may offer the health savings accounts option or individual voluntary accounts through a bank or financial institution (Berchick, Hood, & Barnett, 2019). One should be below 65 years old to be eligible to have a health savings account and have a high-deductible health insurance plan, which must be the only health insurance.
Government Health Insurance
Government insurance is a public insurance plan that covers individuals to reduce the cost of healthcare services. There are three common types of government health insurance: Medicare, Children’s Health Insurance Program, and Medicaid. Under the Medicare plan, the government provides medical cover to US nationals aged above 65 years and younger individuals with renal diseases and disabilities. The Medicare plan is divided into four major plans. Firstly, Plan A covers hospitals, skilled nursing, and hospice services, while Plan B covers outpatient services (Rowell & Green, 2002). Subsequently, Plan C allows patients to select health plans that suit their needs, while Plan D covers self-administered prescription drugs. In addition, the Children’s Health Insurance Program covers children’s health costs from modest incomes that do not meet the Medicaid threshold. Accordingly, the plan focuses on cushioning low-income earners from being locked out of the health insurance programs. Subsequently, the Medicaid plan helps people with limited income and resources access healthcare services by covering the benefits normally not covered by Medicare. On the other hand, Medicaid focuses on the economic aspect of the beneficiaries and also the marginalization or vulnerability of individuals in society, like the disabled. The Patient Protection and Affordable Care Act expanded the coverage of Medicaid by allowing Federal funding for citizens with income of up to 133% of the poverty line.
References
Berchick, E. R., Hood, E., & Barnett, J. C. (2019). Health insurance coverage in the United States: 2018 (p. 2). Washington, DC: US Department of Commerce.
Green, M. (2018). Understanding health insurance: A guide to billing and reimbursement. Cengage Learning.
Rowell, J. A. C., & Green, M. A. (2002). Understanding health insurance: a guide to professional billing. Cengage Learning.
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Question 
Medical Billing Manual
Introduction:
In order to properly code a bill for medical necessity, it is important to understand different plans and the requirements for billing each. It is true that they all use the ICD-10-CM diagnosis coding system, the CPT procedure coding system, and the CMS-1500 form, but each type of carrier has certain requirements for a clean bill.
Tasks:
Create a billing manual constructed of summaries of each type of insurance.
Include the major billing requirements for each type.
Note inpatient or outpatient differences where appropriate.
Explain how to determine from the patient which type they subscribe to.