Final answer:
Outpatient tests are reimbursed based on International Classification of Diseases (ICD) codes, which are used throughout the healthcare system to ensure proper treatment and facilitate insurance claims. Part B insurance covers these outpatient services with various costs shared between the enrollee and the government.
Step-by-step explanation:
All outpatient tests are reimbursed according to a group of code numbers known as International Classification of Diseases (ICD) codes. These codes are utilized by clinicians to order laboratory tests and prescribe treatments specific to the illness they suspect. For example, if a patient is being treated for a viral infection, the ICD codes are used to identify the tests needed to confirm the diagnosis, and by the healthcare management system to ensure that the treatments and laboratory work are appropriate for that virus. Medical coders use these codes to assign the proper codes for procedures performed, and medical billers use this information to process claims for reimbursement from insurance companies.
Part B insurance covers outpatient services including physician services and medical tests. Enrollees pay a monthly fee, deductible charges, and copayments, while the government funds a significant portion of the overall costs. Alternatives to fee-for-service arrangements include health maintenance organizations (HMOs), where providers are reimbursed based on the number of patients rather than the cost of services. HMOs face the challenge of allocating resources between patients who need different levels of care.