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Chapter 7: Revenue Cycle Management: Health Insurance and Other Payment Mechanisms

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DOI:

10.1891/9780826144751.0007

Abstract

Our health and wellness are essential, with our shorter-term and longer-term outcomes dependent on the availability and affordability of healthcare services. As the costs of medical care continue to rise, even well-established networks struggle to maintain reasonably priced coverage for a wide range of services. There are several key items that drive rising healthcare costs, some of which are simply a by-product of the provision of care. First, as a result of effective medicine and treatment, some are living longer and delaying retirement. Second, healthcare is a technology-driven industry fostering continuous improvement. With ongoing research and development, and continuous training to ensure highly competent healthcare professionals, increased costs are inevitable. This chapter discusses the major types of healthcare insurers and payers, as well as the segments of the U.S. population they cover. It provides an overview of some key insurance terminology and defines the basics of health insurance coverage.