Medical Auditing Practice Exam

In the healthcare context, a third-party payer refers to an entity other than the patient or healthcare provider that pays for healthcare services. Government programs such as Medicare serve this role by providing health insurance coverage to eligible populations, which includes seniors and certain disabled individuals. These programs reimburse healthcare providers for services rendered to beneficiaries, thus acting as intermediaries in the payment process.

Healthcare providers directly billing patients is not considered a third-party payer because, in this scenario, the financial transaction involves just the provider and the patient. Similarly, pharmaceutical companies and medical device manufacturers are not third-party payers; instead, they are involved in the supply chain of healthcare products and services, but they do not participate in the payment model as described.