Final answer:
Clearinghouses are the entities that handle claims between healthcare providers and insurers. They play a crucial role in the administrative aspects of healthcare, ensuring smooth operations within different health financing systems like fee-for-service and HMOs, which are affected by issues like adverse selection.
Step-by-step explanation:
Entities that receive, review, send, and manage insurance claims for physicians are known as Clearinghouses. These organizations act as an intermediary between healthcare providers and insurance payers, ensuring that health claims are processed accurately and efficiently.
In the context of health financing, fee-for-service systems and Health Maintenance Organizations (HMOs) have different approaches to reimbursement. In fee-for-service, providers are paid per service rendered, while HMOs receive a fixed amount per enrolled individual. Problems such as adverse selection arise when there is informational asymmetry between buyers and the insurance company, potentially skewing the insurance pool toward higher-risk individuals.
In the context of insurance claims for physicians, entities that receive, review, send, and manage these claims are called Clearinghouses. Clearinghouses are organizations that process and transmit electronic claims data between healthcare providers, insurance companies, and other parties involved in the insurance claim process.
For example, when a physician submits an insurance claim to an insurance company, the claim is often first sent to a clearinghouse. The clearinghouse then checks the claim for errors, verifies the information, and forwards the claim to the appropriate insurance company or payer for payment processing.
Clearinghouses play an important role in streamlining the insurance claim process, reducing errors, and improving efficiency in the healthcare industry.