Fee For Service Model

1. Consider key elements of ACA provided on p. 11 in the textbook. Pick any two and discuss. Whether a particular element of ACA has been already successfully implemented? What are the pros and cons of this element? (4-6 sentences)

Cost could potentially be the biggest factor of the iron triangle and perhaps the side of the model that leaves administrators most puzzled. With new technology being released quarterly, drug prices soaring, a new aging population that can't be supported by the current workforce, Medicare cutting reimbursement payments and leaning towards insolvency, and the price per service continues to rise it seems as if cutting costs down may seem impossible. Not only have hospitals and clinics began looking for more cost-efficient ways to provide care or, unfortunately which programs to cut, the political arena has been evaluating this as well. Since Obamacare has not lived up to its true potential and glory an alternative method must be identified before the nation's model of healthcare implodes from high costs.

In healthcare cost physician and other healthcare providers essentially has enter a contract with their patient where they can understand the providers top priority that is first most foremost when it comes to

The term universal healthcare stands for any healthcare system that is managed by the government. It may cover programs such as government hospitals and other health facilities. Universal health care ensures that all the citizens can access preventive and rehabilitative healthcare services that they need. Government management in the system includes payment or subsidizing of medical services. Developed countries around the world have embraced the universal healthcare, with America being the only exception. Access to healthcare is considered one of the most important things for the progress of a country. However, many people in America consider that the healthcare system in the country is quite inefficient. It is estimated that more than 45 million Americans have no medical insurance. The problems associated by such individuals call for adoption of universal healthcare in the country.

Discuss the importance of knowing the processes and procedures used for receiving payment for services rendered under the contract provisions.

When being placed in the role of a manager, it is important to understand the finances of the organization and how to read and understand the recording of finances. It is also important to understand how all the different parts of the records fit together to give us the knowledge of where the business is financially. Knowing also the different responsibility centers related to financial recording and how they function is important as a manager. Once a manager understands what and where items belong on a balance sheet, they will better understand the state that the business is in. “It provides you with a picture of the financial health of your practice or organization on a certain date.” (Arnow & Xakellis, 2001).

Need accurate coding, billing, all of the patient information, Member ID correct primary insurance and secondary insurance, additional forms if medical necessity.

It’s very crucial that the technology proposal includes these recurrent expenses established not only on current amounts, but also on the healthcare organizations’ future situation. In general, upcoming planning expenses have to account the employee’s resources that are required to meet the organizations’ needs. This would entail the support of administrative employee for the technology, overall technical support to maintain the organization’s growth and management capacity to maintain the organization’s strategic planning. This could be kept in-house or given to outside cohorts, but the expense implications of both models must be assessed as a component of the planning process. A lot of work and time should be set aside so the organization can isolate known and estimated expenses and develop and create them within the general organizational plan so they everyone know what they will need to pay for and when. If at all possible, the organizations investments will start to give them economies of scale or additional savings over the years (Nourse,

The chargemaster is one of the most important financial aspect of a healthcare facility or hospital because the amounts listed on the chargemaster is what is charged to the patients. If the chargemaster has the wrong amounts on there, the hospital will be either losing revenue is the costs are lower than what they should be or they will be overcharging the patient. This will also be viewed as committing fraud against CMS and the hospital will ultimately be held responsible and would have to incur fines and penalties. A chargemaster automatically charges patients for all types of services, procedures, supplies and even medications that are provided from a list of prices

For example, hospitals can ensure that all written policies for assisting low-income patients are applied consistently. In addition, hospitals can review their current charge structures and ensure that they are reasonably related to both the cost of the service and to meeting all of the community’s health care needs. Finally, hospitals could also implement written policies about when and under whose authority patient debt is advanced for collection.

You are a new physician setting up your practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several healthy plans to speak with you about the benefits of choosing their plans.

The second case – controlling the market – is where the contrast between small firms and big business contrasts is most evident. The small firm lacks the capacity to influence prices, as both their market share and purchasing power are limited; however, big business possesses an abundance of both. Big business is able to exert their power by influencing prices because their decision to buy can be the difference between survival and failure for suppliers. Furthermore, Galbraith (1967, 30) suggests that the influence of size enables firms not only to control price but also quantity sold. Although Galbraith acknowledges that influence on demand is inexact; One should not discount its importance. Advertising, sales organization, and product design

The Pay-as-you-go model has been highly advantageous in maintaining a department’s budget that has been affected by the reduction of funds from the Treasury Department. By charging a person if and when he uses a department’s service, the necessary funds can be collected without having to increase the local tax-rate for the common man who might never use the service. Unlike taxes, when billed for a specific service, the payments

One of the dominant factors that could motivate intervention in healthcare by the government is equity factor. This factor is being boosted through the implementation of user fee system. The user fee system tends to promote equity through price discrimination, that is, charge the poor less than the rich for a given health service or product. Obviously, price discrimination contributes to the market failure had been seen as an economic rationale to encourage

Based on this case the cost driver is to properly distribute the direct cost among the different divisions. Dr. Julian would like to control her departments costs by having them distributed fairly among the divisions without affecting the hospital’s reimbursement/revenue. Carroll University Hospital is currently using the standard costing unit, which is based on the cost of bed/day for inpatients. Currently the present cost accounting system that is being used at CUH takes the total direct cost of the departments, then allocates the indirect costs and distributes it among the departments evenly regardless of the actual resources being used in those departments, and without considering that there may be some patients in these divisions that may require more resources than others, this method does not seem to recognize the different activities,