Reimbursement Methods Essay

Medicare Shared Savings Program provides and incentive to ACO participants that are capable of lowering growth in Medicare health care costs in addition to meeting performance standards for quality of care and putting patients first. It was not until October 20, 2011 the Center for Medicaid and Medicare Services (CMS) released the final details regarding the ACO that specified the Shared Savings program authorized by ACA. The purpose of the program should improve access to capital precisely targeting those smaller ACO entities which are physician owned and/or located in rural locations. CMS will not pursue recoupment of any advanced payments not repaid from shared earnings, if the ACO completes the full three-year contract term and decides

A chargemaster automatically charges patients for all types of services, procedures, supplies and even medications that are provided from a list of prices

In typical bundled payment models, providers and payers share in savings and/or losses. When actual health care costs fall below the lump-sum payment, both parties keep a portion of the difference as additional profit. Conversely, the provider must provide extra services at a loss when health care costs exceed the lump-sum payment, though payers mitigate some of this loss. The potential for savings for payers lies in upfront discounted payments for episodes of care, as well

As far as the costs associated with health care, they may be concerned with the suggested payment system. Being a CCE, they are required to obtain reimbursement through a risk-adjusted, capitated basis. In addition, patients are allowed to choose health plans that best fit them and can change plans at any point. Furthermore, CCE must compete for patient based on their value and quality of service that they provide. In addition, the providers have various criteria that they must meet.

In the Pioneer ACO pilot program, Medicare will give the ACO a population-based payment worth 50 percent of the estimated cost of care for the payees in the third year of the program if the costs are below the benchmark. Providers will only receive 50 percent of their typical payments in the form of fee-for-service reimbursement, and the ACO will determine what share of the population based payment each provider should receive (Shafrin,2011). The goal of both these project is basically to move towards more integrated care. Medicare put forward a proposal for health care agencies to participate in both the Medicare Shared Savings Program and the Pioneer Accountable Care Organization (ACO) pilot

Managed Care plans are also known as prepaid health care plans. Managed healthcare plans strive to deliver high-quality healthcare, while controlling cost. Services and fees are negotiated with healthcare providers and facilities to provide access to otherwise expensive healthcare services to patients. Services under listed within the Managed Care plan monitored continuously to ensure that all services are provided in the most cost effective manner. An HMO or Health Maintenance Organization is an example of a Managed Care Plan.

Abstract The paper reviews the organizational chart and stakeholders relationships for Sheppard Pratt Health Systems. The organizational chart for each health care organization is different depending on the size and services offer by that organization. Most organizational charts begin with either a board of trustees or the CEO. Stakeholders are anyone who has vested interest in an organization.

Medicare is a federal health insurance program designed to provide coverage for people who are 65 years or older, as well as those with certain disabilities or chronic conditions. Medicare offers several different parts that provide coverage for different types of services. In this post, we will explain the four parts of a Medicare health plan. Part A: Hospital Insurance Part A is the portion of Medicare that covers hospital stays, hospice care, and skilled nursing facility care. Most people who have paid Social Security taxes for at least 10 years are eligible for Part A without having to pay a monthly premium.

Understanding the importance of provider reimbursement and the different methods of healthcare financing can be beneficial. This can aid in understanding which financing method provides the most benefits to providers. Healthcare providers along with healthcare organizations require funds to assist in the continuation and the revolving of healthcare services. References Casto, A. B., & Layman, E. (2006). Principles of healthcare reimbursement.

Research Findings Wellness Program A Wellness Program is a program designed to improve the physical and mental health of a company’s employees. The program can consist of physical fitness programs, nutrition and dietary information, smoking cessation, stress management, and health screenings. A Wellness program focuses on preventative measures with lifestyle changes in physical fitness, nutrition, mental health, and stress management.

Mapleton Family Medicine can be closely compared to countless other family medicine facilities throughout the US, a small family practice establishment struggling to keep up with providing fast but efficient care within a small city. With wanting to raise productivity without hindering patient care, the owners have hypothesized an incentive system plan to move the establishment in the right direction. However, will the plan actually be effective in accomplishing these goals? Based upon the case questions within the experiential exercise, I will work to answer any problems addressed, giving away to a better understanding of the possible obstacles within the development of their incentive system plan.

It be treated in the public hospitals and clinics that is supplied by public insurance since it lacks the least facilities that can treat any patient, consequently low, middle, and high income families shift to private insurance since it can provide the least facilities. Adding to that, private insurance can provide a plan of payment according to the patient’s salary, but each plan has its benefits and coverage. Some other private insurance have special enrollment periods. For instance, according to HealthCare.gov (2015)“ special enrollment period such as having a baby, getting married or moving to a new

One of the dominant factors that could motivate intervention in healthcare by the government is equity factor. This factor is being boosted through the implementation of user fee system. The user fee system tends to promote equity through price discrimination, that is, charge the poor less than the rich for a given health service or product. Obviously, price discrimination contributes to the market failure had been seen as an economic rationale to encourage

Julian is able to recognize which patients, and which of the three divisions: gastroenterology, cardiology, and oncology is using more of a variety of resources, since some patients do require more medication, lab work, and therapeutic treatment, based on the patient’s diagnoses. The information from the third system will provide Dr. Julian the ability to recognize and distinguish that not all patients require the same amount of care, some patients due to their diagnosis require different level of nursing care, some more than others. With this third approach Dr. Julian will be able to have a more precise cost of care service given to the different patients based on their necessities. The information provided by both second and third system will provide Dr. Julian with a more efficient way to control costs. She will now able to see the differences in costs among the divisions using the second and third approach.

Holiday Inn is a world wide chain and its international functional strategies will always yield profitable returns. The potential customers are from all over the world. It has been noted that the holiday inn company has given the market such as Europe, Asia, America with regards to their social-cultural needs. Holiday Inn, like all other hotels has established a good system in determining the needs of the market. The company uses the concept of product, personality, behaviour of the customer and purchasing to its advantage.