For this assignment, you will be researching (the internet or your textbook) and discussing information related to Third-Party Payers. In order to complete the assignment you first need to define what or who is a Third-Party Payer in the medical field. Then respond to the questions below.

Part 1. Define Third-Party Payer and what organizations or companies might they represent?

Part 2.

Reply to the following questions as the medical professional responsible for billing and collections in the clinic. What communication and responses both verbal and nonverbal would be most appropriate in each of these instances?

1. You are on a phone call with one of your providers accepted insurance plans explaining that the clinic has not received reimbursement for the previous 2 month's billing. The person you are speaking with is abrupt and insists the reimbursement checks were mailed and the clinic must have lost them!

• How would you interact professionally, over the phone, with this third party representative to find out what happened to the checks?

2. You have to tell your provider that a test they are ordering will not be covered by the patient's insurance and the provider will not be reimbursed. The provider insists that you investigate further.

• How would you display tactful behavior when communicating with your medical provider regarding third-party requirements and coverage for the test they are ordering?

3. You have to inform a patient that Medicare will not pay for one of the lab tests the provider ordered as it is not a covered benefit. The patient is concerned as they are on a fixed income but know the test is necessary for their diagnosis.

• How would you show sensitivity when communicating this information to the patient regarding the cost of the test and third-party requirements?