Provider Reimbursement In Healthcare

An ethical issue related to medical care is pain management and the inappropriate judgment of patients being labeled as “Drug Seeking”. There are statistics that prove there is a rise in abuse in opiates within communities. However, at what point does the nurse or provider get to decide what is an adequate pain threshold and how much they should endure? When does the ethical duty to relieve pain and suffering subside to personal biases? Patients deserve to be treated with dignity and respect as they entrust medical providers to relief their pain and suffering.

In other words, if many people are making decisions, the decision-making process can be less effective. Nonprofit organizations have little interest above and beyond the patients and providers, but not every insurance or healthcare organization is nonprofit. When investors have a stake in the healthcare system, the patient is often removed from the number one priority list and replaced with priorities involving increasing profits and reducing expenses. Additionally, many insurance companies retain the right to deny services, treatment and access to non-network providers, which means even if the provider says the treatment is necessary, the insurance company may deny the coverage for its own

The author writes about different stories of how families become bankrupt or unable to pay the total cost of the treatment to the US hospitals and related medical facilities. According to Steven Brill’s article, the US hospitals prescribe too much health care to patients. He claims that pharmaceutical companies get high gross profit margins by producing drugs. The prices people pay to hospitals in the US are unreasonably high compared to the real costs of treatments and drugs they receive.

Despite improvements, racial minorities and people that suffer disabilities often face more health care disparities that lead to health inequalities including forced sterilization and an increase in cervical cancer. For instance, the American Indian/Alaska Native population is a prominent minority community that faces health disparities. In the United States, there is currently 567 federally recognized American Indian/Alaska Native tribes and 2.9 million individuals identify themselves as American Indian/Alaska Native natives alone (Dugi, 2017). These individuals continue to die faster than other Americans in many categories that can be attributed with the health disparities this population endures (Dugi, 2017). American Indians/ Alaska Natives

The expansion of Medicaid through the implementation of the Affordable Care Act (ACA) has initiated many states to try innovative ideas to improve their Medicaid programs. Many states, like Minnesota, had started the reform process prior to the passage of the ACA with the purpose of improving the quality of care for Medicaid beneficiaries and to utilize a more cost-effective system to provide Medicaid benefits. One of the innovative ideas that states like Minnesota is implementing is the use of accountable care organizations (ACOs). This paper will explore ACOs by studying the reforms within the Minnesota Medicaid program.

It also helps for reimbursements and if the services that were rendered were medically necessary.

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

Expanding accessibility to affordable healthcare insurance is one way in which our country can begin to increase healthcare that is patient and family centered. One reason for existing disparities are the expenses associated with seeking healthcare. For some people, while the actual monthly payments of their health insurance is affordable, patients still face high deductibles or high out of pocket maximums. By making health insurance attainable for the majority of Americans, this alone is only the first step toward reducing some of the existing health disparities. Money alone is a factor that can deter people from seeking preventive treatment and screenings. I too suspect that the results of the affordable care act will not be seen for a few more years. Hopefully, as more people become insured and as health insurance is more in demand, accessibility and affordability will continue to improve.

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.

One of the most popular health plans that people use is Medicare. One of the reasons why this is so is because it is public and goes towards making health coverage more possible. One payment plan states that people pay $104.90 monthly, with a $147 dollar deductible. Another payment plan under Medicare states that one has to pay $407 dollars monthly at the most. ("Medicare", 2015). The third payment plan varies and is dependent on the plan that they are using. Because the medical industry works to become more and more accurate in all medical terms, it is necessary for patients being just as accurate when applying (2015). This way, clients will get just the health plan they need.

The University of Pittsburg Medical Center (UPMC) has taken a unique approach to improving revenue and reducing bad debt. By taking “a proactive, patient-friendly approach to communicating with patients about their financial responsibility through an integrated revenue cycle model,” UPMC has increased patient payments from an average of $16 million per month in 2012 to an average of $20 million per month since March 2013 (Langford, 2013, p. 88). Additionally, UPMC has been able to “significantly reduced bad debt and enhanced patient relationships through greater financial advocacy” (Langford, 2013, p. 88). In the fiscal year of 2009, UPMC’s bad debt accounted for 52% of UPMC’s uncompensated care, and as of 2013, the bad debt accounts for 24%

What are the definitions of and the similarities and differences of the following reimbursement methods; capitation, discount, per diem, case rate, DRG’s/MS-DRG’s?

In the film Escape Fire the Fight to Rescue American Healthcare, there were many insightful examples of why our Unites States healthcare revolves around paying more and getting less. The system is designed to treat diseases rather than preventing them and promoting wellness. In our healthcare industry, there are many different contributors that provide and make up our system. These intermediaries include suppliers, manufacturers, consumers, patients, providers, policy and regulations. All these members have a key role in the functionality of the health care industry; however, each role has its positives and negatives. Each person with an occupation in the healthcare industry is doing their designated job as assigned, but it’s evident that the system’s design is flawed to its core.

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.

Governments throughout the world intervene in the health sector. It is hardly for any economic activity to be free from the government intervention. In Malaysia, the government intervention shown in the three main categories, including provision of goods and services, redistribution and regulation under the dominant scopes of financing, production or delivery as well as regulation of healthcare industries (Folland, Goodman, & Stano, 2010). Undeniably, there are many factors could motivate intervention in healthcare by the government such as equity, efficiency and monopoly power. It is true that all these factors are arises due to the existence of market failure which acts as an economic rationale for government intervention.