Administrative Healthcare Data

Chapter 1: The U.S. Healthcare System

Introduction

Data and Programming Used in This Book

Terminology

Flow of Administrative Healthcare Data

Key Players

Medical Claim Submission

Claim Processing

Recent Legislative Effects

HIPAA

Affordable Care Act

All Payer Claims Database

Continuing Enhancements

Conclusion

Introduction

The U.S. healthcare system is massive, multifaceted, and complex. So is the data that it produces. Your annual visit to the doctor generates data. If you are insured, a form of this data makes its way to your health insurance company, which reimburses your doctor for your care. When you pick up a prescription at your local pharmacy, another type of healthcare data is created. If you give birth at a hospital, the hospital produces ...