CHAPTER 4

How Codes Are Used for Reimbursement

The Price Is Right

When you go to the grocery store and purchase a can of beans, you are pretty certain that you are being charged the same price as everyone else, the price that is posted on the shelf. If you pick a different brand the price may be higher or lower, but once again the price will be the same for everyone. But—wait a minute—if you have a supermarket discount card for the clerk to scan, your price after the discount could be less.

Healthcare prices work the same way. If you are a self-pay patient with no insurance, you will be billed the full price and will be expected to pay it. If you have medical insurance, your insurance company will be billed the same price but will pay less, due ...

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