Healthcare Industry And Health Insurance Essay

Healthcare Industry And Health Insurance Essay

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Healthcare industry is extremely expensive to maintain and operate. Each facility has to purchase equipment, billing systems, electricity, etc. to provide care to patients. Not only does the facilities have to provide material items, but most importantly payroll for staff such as doctors, nurses, and billers. All these mention cost money. Therefore doctors’ bill charges for their procedures and services they provide. It is the responsibility of insurance carriers and patients to reimburse for the charges rendered.
Provider reimbursement is what keeps providers in business. It means to pay back. The facility pays upfront, then the responsible party pays the facility back. Insurance carriers and patients are held responsible for paying for services provided. If providers did not generate money, they would be unable to keep their doors open. Insurance carriers will receive a claim that indicates the charges rendered and patients will receive a statement from the particular facility one was seen at. Providers have several reimbursement methodologies.
Medicare is a well-known Government funded health insurance program. Medicare covers people age 65 or older, ones with certain disabilities, and ones with End-Stage Renal Diseases (CMS, 2015). Medicare has two insurance types, part A and part B. Patients with part A usually do not have a premium and this plan is used for hospital care. Part B patients have a monthly premium and use this for medical expenses for outpatient care. Medicaid is also a Government funded health insurance program but their guidelines vary by state. Each state funds their Medicaid program. Each state has its own requirements, the state program has an enrollment process one must go through to determine if eligibl...


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...s of the length of treatment. This seems to be a risk taker for both the providers and patients. Patients want the best care and treatment but providers have an incentive to choose the least expensive methods of care, which partially can cause a decline in the quality of the care of patients. The most stable is PPS as a study found that there was improvement on quality of care (Rand, 2015). The study also found that the quality of care improved for the post-PPS.
Provider reimbursements play many factors in the healthcare industry as there are many guidelines and policies in place for providers to receive reimbursement depending on the methodology. All the above methodologies are key factors to helping providers continue care each day. Not only are they important for providers but also for patients who need coverage for treatment and maintain a healthy lifestyle.

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