Final answer:
To be paid for a medical service, providers need to establish the medical necessity and ensure billing compliance with healthcare regulations, including insurance reimbursement models like fee-for-service and HMOs, and legal standards like HIPAA.
Step-by-step explanation:
In order to be paid for a service/procedure, a provider must establish medical necessity and billing compliance. In a fee-for-service health financing system, medical care providers are reimbursed based on the individual services they perform. Conversely, in health maintenance organizations (HMOs), providers are compensated with a fixed amount per individual enrolled, regardless of the number of services rendered. Understanding and navigating the various health insurance reimbursement models is critical to ensure that healthcare providers receive payment for their services without running afoul of legal issues such as those contingent upon the Health Insurance Portability and Accountability Act (HIPAA) which governs patient data privacy.