Introduction
One thing that is consistent in healthcare is that healthcare is forever evolving. With the concept of evolution one particular area that plays a major role in how healthcare system evolves is revenue and the other is how the healthcare facilities get payment for the services provided. When exploring healthcare services reimbursement there are checks and balances that must take place. The healthcare provider orders services such as radiology and laboratory services just to name a few of the services that can be provided to a patient. Next the facility, whether it being the hospital or doctor’s office sends a claim to the insurance company and depending upon how the healthcare facility has coded the service and the documentation …show more content…
There is an article written titled “Why is the laboratory an afterthought for managed care organization?” In this article the author Forsman discusses how the market has played a major impact in healthcare and its delivery and that though these changes have occurred or may continue to change, the laboratory should not look at these changes in a negative light. Forsman goes on to breakdown statically the role of the laboratory by explaining how the laboratory only makes up 5% of the hospital’s budget. This particular number is why the laboratory is not looked at as a priority because the laboratory is just a small piece of a larger picture. However, 60-70% of all critical decision-making such as admittance, discharge and medication is based solely off the laboratory results (Forsman …show more content…
In addition to the codes being added to the fee schedule prices are created to support the service(s) that are being rendered. One particular services that does not waiver in the amount that is being charged for service is a cervical or vaginal smear test commonly known as a pap smear must not be less than the national minimum payment amount (Fee Schedule 2016). The initial amount for a pap smear was set at $14.60 and is updated each year due to inflation. On the other the other hand hospitals that handle critical situations are paid for their outpatient laboratory services on a reasonable cost basis instead of the fee-for-service basis (Fee Schedule
One thing that is consistent in healthcare is that healthcare is forever evolving. With the concept of evolution one particular area that plays a major role in how healthcare system evolves is revenue and the other is how the healthcare facilities get payment for the services provided. When exploring healthcare services reimbursement there are checks and balances that must take place. The healthcare provider orders services such as radiology and laboratory services just to name a few of the services that can be provided to a patient. Next the facility, whether it being the hospital or doctor’s office sends a claim to the insurance company and depending upon how the healthcare facility has coded the service and the documentation …show more content…
There is an article written titled “Why is the laboratory an afterthought for managed care organization?” In this article the author Forsman discusses how the market has played a major impact in healthcare and its delivery and that though these changes have occurred or may continue to change, the laboratory should not look at these changes in a negative light. Forsman goes on to breakdown statically the role of the laboratory by explaining how the laboratory only makes up 5% of the hospital’s budget. This particular number is why the laboratory is not looked at as a priority because the laboratory is just a small piece of a larger picture. However, 60-70% of all critical decision-making such as admittance, discharge and medication is based solely off the laboratory results (Forsman …show more content…
In addition to the codes being added to the fee schedule prices are created to support the service(s) that are being rendered. One particular services that does not waiver in the amount that is being charged for service is a cervical or vaginal smear test commonly known as a pap smear must not be less than the national minimum payment amount (Fee Schedule 2016). The initial amount for a pap smear was set at $14.60 and is updated each year due to inflation. On the other the other hand hospitals that handle critical situations are paid for their outpatient laboratory services on a reasonable cost basis instead of the fee-for-service basis (Fee Schedule