Instruction:
Compare and contrast the major third-party payers in medical reimbursement.
Information on Third-Party Payers from the textbook:
Third-Party Payers:
A third-party payer is an organization or company that provides reimbursement to health care providers for services rendered to a third party such the patient and her or his dependents.
Payers serve as carriers and fiscal intermediaries (FI) for Medicare by processing claims for physicians (Part B) and healthcare organizations (Part A), respectively. Payers also function as Medicare administrative contractors (MACs) by processing both Medicare Part A and Part B claims. Third-party payers include: Blue Cross and Blue Shield (BCBS), commercial insurance companies, employer self-insurance plans, government-sponsored programs such as Medicaid, Medicare, and Tricare, managed care such as health maintenance organization and workers’ compensation.
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