The Role of Reimbursement in Healthcare


July 19th, 2008


Healthcare reimbursement refers to the use of coding and billing software by health information and medical records technicians to decipher what type of medical coverage and reimbursements apply to patients and healthcare providers.  Health information and medical records technicians that work in the reimbursement sector of the healthcare field work as one of the few jobs in the field that are not hands-on working with hands-on care with patients.  Technicians of this sort can be found in a number of healthcare providers including, hospitals, doctor and medical offices, home health care services, and clinics, and usually have an associate degree in the field.  Common coursework in health information technology includes medical terminology, health data standards, laws and ethics, reimbursement procedures, and coding and billing software systems.Healthcare reimbursement is one of the most important branches of healthcare as it ensures payments are secured for healthcare services.  Today’s complex system and technologies referring to healthcare insurance and payment systems are complex and change frequently.  Specialists in healthcare reimbursement know how to read and interpret medical records to gather information about patients such as their medical histories and current procedures and visits.  While serving as liaisons between healthcare providers, insurance providers, and patients, they submit the necessary insurance claims and deal with rejected claims and issues in billing and reimbursement.  They also know how to use coding systems and software such as DRG’s, RBRVS, and APCs, which are diagnostic related grouping payment systems related to the field.Healthcare occupations are amongst the fastest growing fields in the business world, with 10 of 20 being healthcare related.   Employment projections in healthcare reimbursement positions are expected to grow must faster than the average job, according to the Bureau of Labor Statistics.  Medical records and health information technician jobs are expected to increase by 20% by 2018, bringing at least 35,000 new jobs.  With such high demand positions, ideal candidates are also preferred to be well trained, hard-working, ambitious, and have some form of training relating to billing and coding software and procedures.


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