AAS- Medical Office Procedures Week 2 Discussion Judy Potts Explain why pharmaceutical representatives leave samples of expensive medications with physicians. Pharmaceutical representatives, show the physicians the newest drugs on the market, to drum up business for the pharmaceutical companies. The representatives leave samples of the products, In hopes that the doctor will strat prescribing their new name brand products for his patients instead of generic drugs.Also, in some cases, the patients are not financially able to purchase a new drug not knowing if it will help with their disease.The clinic 's management staff will determine whether they will be except the newest medication samples from the representative. If it is a useful product to the physician and their patients that the clinic serves.These pharmaceutical companies offer gifts and meals to the doctors.Such as free services to physicians, like building websites or providing free web pads with the name of the pharmaceutical products on them. Moreover, did you know that these pharmaceutical companies can collect information on the patients?Which is legal as long as they do …show more content…
Here 's an example: beginning with tier 1, it may include a few name brands that have no generic equivalent mostly generic drug on this tier. On these drugs, there is a small co-pay.Tier 2 may have brand name drugs, with the patient paying a higher co-pay. Tier 3, on this tier the drugs would be name brand medication that has a generic form or similar name brands that would cost the patient a lot less co-pay. This tier is the highest out of pocket cost. Like Tri-care, the only drug they will pay for is generic unless the drug does not come in a generic form. Then the patient has to pay a co-pay that is usually 20% or 50 % of the
As far as the costs associated with health care, they may be concerned with the suggested payment system. Being a CCE, they are required to obtain reimbursement through a risk-adjusted, capitated basis. In addition, patients are allowed to choose health plans that best fit them and can change plans at any point. Furthermore, CCE must compete for patient based on their value and quality of service that they provide. In addition, the providers have various criteria that they must meet.
Ronetta Lewis HSA 3430 Chapter 3 Exercises 3.8: Patient pays: 0.2x800= $160 / Insurer pays: $800-160= $640 3.9: 0.2x10,000=2,000 (coinsurance) / 2,000+1,000 (deductible)=$3,000 You’d have to pay $3,000 directly. Case Study 3.2 • It would make sense to become a network model HMO because it has a variety of contracts with different physicians, groups, and IPAs. As we are all well aware of, it takes a team of medical professionals to be successful. • I would like to get my primary care at a patient-centered medical home because I feel like I would be receiving necessary treatment at all times (with no ulterior motives).
The services offered free or low out of pocket expense. Health entities are allowing patient’s to be self-pay if they opt not to go through their high deductible plans. Discount rates seems to be cheaper at some practices. For example; my eye doctor appointment can easily run me over $600 with insurance and only a $150 reimbursement for eyewear. However, my daughter went
My career I chose is pharmacy technician. I think I would like to become a pharmacy tech because I like to be one on one with someone. Another reason I would like to become one is because I could work in any pharmacy. Being a pharmacy technician would allow me to have a flexible schedule. It would also be good I the future because later I could go back and get a degree in pharmacy.
This comes with higher reimbursement, and lower copayments and lower deductible unlike the HMO. With this
(Danielle M, 2014). Private insurance and public insurance coverage cover some of the drugs for certain patients and leave the heavy cost for patients to pay on their own. Another example that elderly people face is the home care that they need to cover. As
This type of health insurance is typically provided by the patient’s employer. Patient payments are in connection with third-party payers. Usually, patients with third-party payers are responsible for a percentage of the services
A HMO is a plan that provides comprehensive health care services, with an emphasis on preventive care, for a fixed (capitated) payment. HMOs are the most stringent form of managed care. Participants must select a primary care physician, who acts as a “gatekeeper” for most services covered by the plan. If the patient does not channel care through the gatekeeper and obtain care at one of the HMO’s participating facilities, it is generally not covered under the plan. There are two basic types of HMOs — the group or staff model and the independent practice association (IPA).
AAS MBIC 117 -Medical Office Procedures Week One Discussion Judy Potts What are some examples of the skills and education required of a medical office manager? Medical office manager also knows as healthcare office manager, someone that is in charge of the overall office and it is operations. ”In a group practice, a medical office manager” oversees the administrative staff which includes billing, medical records, medical receptionists, and technicians. They also do the hiring and training. He /she educational requirement should be as follows, basic computer and data entry skills.
The most common Medicare managed care types are HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and PFFS (Private-Fee-For-Service) plans. There are several benefits in having a Medicare managed care plan instead of traditional Medicare. Medicare managed care plan patients set their own deductible and copays, while traditional Medicare plan patients pay the premiums, deductibles, and coinsurances set by Medicare. Medicare managed plans can also cover extra services that traditional Medicare does not offer. Examples of such services include dental, vision, and hearing care.
Advancing “Medical Homes” for children in foster care. In 1967 the American Academy of Pediatrics introduced the term Medical Home concept. “Medical Home model includes the following guiding principles or the seven “C’s”: accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent.”) Jaudes, Champagne, Harden, Masterson, & Bilaver, 2012). In addition, access to pediatric specialists is embraced for children with physical and mental health concerns.
Selection of wrong medication due to misdiagnosis. Often go over the counter when they have lost their effectiveness as prescription drugs due to resistance and overuse. Restricted over the counter
The designation of POS refers to the fact that the amount of co-payment an insured pay is dependent upon the “point of service.” If an insured member goes outside of the plan network to receive care, the co-payment is higher, as network providers have agreed to accept a discounted rate for services in return for patient volume and patient
The challenges associated with it include the difficulty of defining the boundaries of an episode (what care falls within and outside of the episode); its potential to increase barriers to patients’ choice of provider and or geographic preferences for care if adoption is not widespread; lack of incentive to reduce unnecessary episodes and the potential to avoid high-risk patients or cases that may exceed the average episode payment (Silversmith, J., 2011). For example, Geisinger Health System’s ProvenCare: as a bundled payment model for coronary artery bypass graft (CABG) surgery (AHA, 2010). This appears to be a case rate in which the hospital and the professional fees were each paid a single fee for inpatient and physician services during hospitalization. In the essence there is warranty period of coverage if there is readmission within 72 hours and the patient is covered when the patient comes back for complications within that time period, all services are covered and the patient would not need to pay any additional money for hospitalization. Furthermore, since CABG is
POCKETING THE GREENS Every incorporator has their own responsibilities towards the company they are serving. Also, every company faces its own problems and the success of the business relies on how the management handle these problems. This case study is about how the directors try to solve the problem of the company. 1.