How is a reimbursement rate defined?

• A. The amount paid to the hospital for a treatment and the number of codes used
• B. The doctor's salary
• C. The cost of equipment only
• D. The patient's copay

Answer: (A)

The concept being tested is what the reimbursement rate represents in medical billing. Reimbursement rate is the amount a payer pays for delivering a specific treatment, and that payment is determined through the codes used to describe the service. The codes (CPT, ICD, etc.) convey exactly what was done, and the set of codes used can influence the total payment because each code has its own assigned value within the payer’s price schedule. So, the rate is defined by the payment for the treatment and the coding used to bill for it.