Reimbursement

Healthcare systems in the United States struggled with other countries two basic aspects of health care finance and delivery. The US spends more money on insurance than any other country. In fact, The Affordable Care Act was implemented to allow a market for people to have access to insurance at an affordable rate. To achieve the goal of universal coverage of health insurance the Patient Protection and Affordable Care Act was signed into law. The Affordable Care Act’s core achievement is to…

instance, the Medicare new payment methodologies include MS-DRG, APC, ASC, Home Health, IP Rehab, and Long-Term care. In addition, many consumers face changes due to the shift from volume to value-based reimbursement because many are beginning to invest in systems that increase the value-based reimbursement (Managed Healthcare Executive, 2015). For instance, the UnitedHealth Group is using the Optum system, a data and analytics and technology solutions company, which allows the UnitedHealth…

and coding procedures; (b) improve reimbursement by enhancing software, supplementary training, or hiring additional staff to accommodate the workload; (c) consider replacing the BM due to insubordination and ineffective billing, and (d) implement routine chart audits for billing and coding to improve reimbursement rates. Renegotiating insurance contracts and acquiring additional credentialing may also improve reimbursement rates and revenue. As reimbursement becomes more effective, this…

Work Reflection Log Two Audience/Client The client that I communicate with in a business situation is an insurance provider representative. For every insurance company that the practice is contracted with, an insurance representative is regionally assigned to service a contracted medical provider. Currently our practice is contracted with several major insurance companies which include Aetna, AvMed, BlueCross BlueShield, Cigna, Coventry, GEHA, GHI, Humana, Molina, Medicare, Rail Road Medicare,…

received much opposition from the United States as well as the medical industry. The benefits of using the ICD-10 are the in depth details of the new codes, a more accurate payment system for new procedures, fewer miscodes, and rejected improper reimbursement claims. The United States is one of the last to adopt the ICD-10 system; most other industrialized countries have already been using ICD-10. About ten years ago when ICD-10 first came out the trouble with implementing the system was because…

for the laboratory and other healthcare disciplines to evolve in the ever-changing healthcare environment. There are three significant trends in healthcare that directly involve the laboratory. These trends are: value-based versus volume-based reimbursement, Lean/Six Sigma processes, and Point-of-Care Testing.…

DRGs or Diagnosis-Related Groups determine Medicare reimbursement rates for hospitals. Hospitals receive reimbursement for various procedures based on DRGs despite actual final cost. The DRGs are assigned based on ICD codes, conversion to ICD-10 will unavoidably impact reimbursement rates. The Center for Medicare and Medicaid (CMS) has communicated that they will begin to optimize DRGs once ICD-10 data becomes more…

Cost accounting is very important in the healthcare system, but may be considered difficult and resource intensive. Applications such as the Electronic Medical Records (EMR) have been the primary focus of many organizations. There is a lot of pressure from all stakeholders to lower healthcare cost. Cost accounting analyzes the cost structure of an organization by gathering information about the costs incurred by the organization and assigned cost to products and services rendered in order to…

issues with these changes. The Recovery Audit program was launched by Centers for Medicaid and Medicare Services (CMS) with the intention to "identify and recoup Medicare improper payments." Computer software is used to review all Medicare reimbursements…

Primary drivers for this situation are state regulations, and reimbursement methodology established by Medicare that only reimburses for transport to an ED. The end result of these policies is higher and higher demand, along with escalating healthcare costs. Estimates show that up to 15% of patients seen in the ED, transported…