Ans) Reimbursement is the act of compensating someone for an out-of-pocket expense by giving them an amount of money equal to what was spent. Reimbursement is also used in insurance, when a provider pays for expenses after they have been paid directly by the policy holder or another party.
- When a hospital treats a patient and spends less than the DRG payment, it makes a profit.
- Increasingly healthcare reimbursement is shifting toward value-based models in which physicians and hospitals are paid based on the quality—not volume—of services rendered.
- An explanation of benefits (EOB) is the insurance company's written explanation regarding a claim, showing what they paid and what the patient must pay. The document is sometimes accompanied by a benefits check, but it's more typical for the insurer to send payment directly to the medical provider.
- The EOB is not a bill. It simply explains how your benefits were applied to that particular claim. It includes the date you received the service, the amount billed, the amount covered, the amount we paid and any balance you're responsible for paying the provider.
Reform of reimbursement systems for healthcare services provided to ambulatory patients began in 1992. Spurred by effective curbs in the acute care setting, Congress authorized DHHS to design and implement reformed payment systems in many settings for ambulatory patients. Questions: Discuss the impact these reimbursement systems have had on physician offices, ambulatory surgery centers, and hospital outpatient services. In your response, discuss the benefits and advantages of the ambulatory and outpatient reimbursement system.
Explain how financial reimbursement is impacted by proper nursing documentation or inability to document appropriately in the united states. 150words
Explain Medicare, Medicaid, and other managed care programs and how they relate to reimbursement, population need and the role of health administrator.
There is a general shift in reimbursement for healthcare services from a volume-based (more patients, more income) to a value-based (better patient outcomes, more income) emphasis. Is this shift working? For whom? Why or why not?
Suppose that the Medicare rate of hospital reimbursement is reduced. costs may not be shifted to other patients in the short run. Explain why the costs may not be shifted to other patients in the short run.
This week we learned about intermediate hospital inpatient coding. Discuss the MS-DRG reimbursement and explain how coders impact the MS-DRG assignment. Must be 3 paragraphs in length.
With all of the new rules and regulations for CMS reimbursement it is becoming difficult for facilities to receive full payment for the services they render. In your opinion, should the patients experience or satisfaction be a primary driver for reimbursement or should reimbursement be determined by the patient's outcomes primarily?
Explain how act utilitarianism, rule utilitarianism, and Kantian philosophy bear on the issue of deceiving patients, as discussed by Cullen and Klein and by O’Neill. Explain what your own views are on the issue of deceiving patients.
Describe the importance of proper coding in healthcare to ensure prompt reimbursement by answering the following: 1. describe the role of finance in the healthcare system 2. describe the diagnosis codes and how they are used impacting reimbursement 3. describe the features of third-party-payers 4. explain the reimbursement methods used and the effects of coding on reimbursement
Explain in detail by typing your feedback to the uniform hospital discharged data set and reimbursement and justify what correct coding should be.