Write a 750-1,000-word essay about the different types of health care payment options. Address the following in your essay:
1. Explain how the charging and pricing processes of health care
facilities are different from those of other industries.
2. Explain how private and government insurers and payers impact
actual reimbursement.
3. Explain the impact that these payment structures have on the
strategic planning of a health care facility.
Ans) 1) Health care charging and pricing processes are different from other industries in that many other industries have automated processes. Health care services is essentially anti automation. This is because advances in technology has not had the same impact that one would see in these other industries. Health care requires technology to be applied in a patient by patientway. Another factor that affects charging and pricing is that health care is localized. This mean that the services must be provided locally which affects the price. The price is affected because health care organizations are in competition with the local community with little to no unemployment with skilled workers for high quality and higher costs. Health care patients cannot be denied services because they did not pay for previous services rendered whereas in other industries, the customer will not be able to receive services any longer if they are not making payments on their bill. The reimbursements processes and the way billers and coders are a part of the process.Medical billing and coding compliance is the primary and utmost essential stage in medical billing reimbursement. The Health Insurance Portability and Accountability Act, otherwise known as HIPAA and the Office of Inspector General or OIG have necessary procedures that must be followed in front of bills being submitted or accepted for payment. The correct ICD code must be used for the procedure that the patient received in order for the billing aspect to be deemed correct.
2) In most industries, paying for a service or item is straightforward. You see the price, make the payment, and receive the item or service. The entire transaction takes a matter of seconds. Healthcare reimbursement is far more convoluted. The biggest difference between healthcare and other industries is that providers are paid after services are rendered. Healthcare reimbursement is often a month’s long process that requires multiple steps, each of which can go wrong at any moment, further delaying payment to the provider and potentially saddling patients with bills they don’t understand and therefore don’t pay. Ultimately, healthcare reimbursement in full isn’t even a guarantee.
3) Strategic management also provides several benefits for healthcare organizations to become more proactive with strategy: It allows organizations to be nimble. A good strategic management approach ensures that communication and feedback on performance against strategic goals occurs on a regular cadence.
- Our experiences suggest that even where the technology exists and efforts have been made to introduce it, its full potential is not being realized. We believe that shared consistent action is now needed across all payers—commercial and governmental—in partnership with physicians and hospitals calling for tighter data and transaction standards, seamless health information exchanges, automated processes to replace antiquated manual systems, and standardization of such processes as credentialing and quality measurement.
- With this commitment, we should be able to identify and support only those value-added administrative programs including those that make a substantive contribution to achieving better care.
- The momentum is building. America’s Health Insurance Plans, the Council for Affordable Quality Healthcare, the American Medical Association, and others have been working with government and the private sector to address the opportunities outlined herein. Key to that success will be to first lay the foundations of tighter standards and information exchange through a series of public–private partnerships that overcome traditional barriers to implementation—while maintaining the spirit of innovation that rests within the private sector—and will improve health care for decades to come.
Write a 750-1,000-word essay about the different types of health care payment options. Address the following...
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