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...
... middle of paper ...
...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.
Need Writing Help?
Get feedback on grammar, clarity, concision and logic instantly.Check your paper »
- The history within the health care industry has faced many challenges over the decades; there will be future changes and challenges that are country will have to overcome. Improving health care in the United States can only get better with stronger leaders and new strategies. The United States currently is and has faced many challenges in the health industry. There is not a single sector of the health care industry has not been affected. The healthcare industry contributes a mass majority of factors in the United States the economy.... [tags: Health care, Health economics, Health insurance]
1015 words (2.9 pages)
- Global healthcare issues are defined as areas that can be improved by research and the dedication of the research, taking the responsibility and leadership in order to analyze and find better outcomes for a better heather system and revolution. The world has and will continue to face challenges within the health care industry and with contributions that associated with the health care industry. Many of the global issues that many of us face and issues that have impacts with the health care industry today are defined as some of the following: • The number of people that are still uninsured and/or paying penalties due to not being able to afford to pay for health care insurance • Funding, as w... [tags: Health care, Health insurance, Health economics]
772 words (2.2 pages)
- When studying the resource based view of a firm or industry’s strengths and weaknesses, one of the first industries that may come to mind is the healthcare industry. The healthcare industry is one that must always be evolving and on the cutting edge of technology and implementing change. Thus, leveraging resources is a vital part of being successful in this industry. The resource-based view (RBV) is a model that sees resources as key to superior firm performance. If a resource exhibits VRIO attributes, the resource enables the firm to gain and sustain competitive advantage .... [tags: Health care, Medicine, Health insurance]
803 words (2.3 pages)
- Past Health Insurance Industry Growth Factors Multiple variables including employment, legal, and advance medicine factors contributed to past growth that the health insurance industry experiences. Employment Post world war II, the chance of attracting talented workers back into the workforce is scarce. Many lives and talents were lost in the war and the unemployment rate skyrocketed. Employers were left to fight over a small pool of talents (“Shift to Employer-Based,” n.d). In order to attract the best workers, employers were pressured to increase wages.... [tags: Health insurance, Health care, Health economics]
1928 words (5.5 pages)
- Healthcare organizations are required to be in compliance with the Federal requirements in order to ensure the equipment and patient safety. There are many programs that are responsible of providing health and safety guidelines in healthcare industry. Manufacturer recommendations are not enough to ensure patient and equipment safety in the healthcare industry. There are many healthcare programs now that are needed to be administrated by an agency to ensure that they get the expected outcome in the medical field.... [tags: Health care, Medicine, Healthcare, Hospital]
1017 words (2.9 pages)
- For the last five years of my life I have worked in the healthcare industry. One of the biggest issues plaguing our nation today has been the ever rising cost of health care. If we don't get costs under control, we risk losing the entire system, as well as potentially crippling our economy. For the sake of our future, we must find a way to lower the cost of health care in this nation. Last year the average cost of an insurance policy for a family of four was $20,728.00 according to the Milliman Medical Index (2012 Milliman Medical Index, figure 1).... [tags: healthcare industry, insurance policy]
1143 words (3.3 pages)
- The new IOM report has put a lot of responsibilities on the healthcare industry to change its face from a sick to wellness approach. With this new demand many feel compelled to start a new era in the way of putting the patient at the center of healthcare. With new laws enacted and opportunities at hand nurses have an enormous role to fulfill. Influence by the expectation of the public and our devotion to our calling, great steps are taking to make sure that the patient is receiving excellent care not only in the hospital setting but across the country.... [tags: Health care, Health insurance]
790 words (2.3 pages)
- The health care prices had continued to consume national budget, even individuals the increasing health care cost with the rapid economic growth because money intended for development used for health care. The National Health Insurance (NHI) costs had gradually increased in the recent past, causing a major concern about the impact on individuals, service providers the government, the United States government had adopted the individual approach that had capitalized by nature, thus encouraging private insurance providers to compete for customers (Ubokudom, 2012).... [tags: Health care, Health insurance, Health economics]
1085 words (3.1 pages)
- The healthcare industry’s migration to the cloud is inevitable—driven by an irresistible blend of competitive realities and patient demand. As in any major change in business or technology, early movers tend to reap the benefits. As consumers are becoming more tech savvy, the demand for information at the touch of their fingertips is also becoming more demanding. The move to cloud computing from a healthcare standpoint is taking precedence above the old fashioned way of healthcare. Research has shown that cloud computing is not only good for companies but also for the environment.... [tags: electronic healthcare records]
676 words (1.9 pages)
- Cybercrime is a big concern in society and the healthcare industry is at risk of being a victim just like any other industry. It can cause healthcare costs to rise and increase safety concerns for patients, not to mention it can violate the Health Insurance Probability and Accountability Act (HIPAA). Cybercrime affects all aspects of the healthcare industry including but not limited to consumers, healthcare providers, payers and pharmaceutical companies. The purpose of this research paper is to state facts about cybercrime and the effects it has on the healthcare industry, what actions can be taken for prevention , as well as my opinion on the issue.... [tags: Health care, Health care provider, Patient]
1562 words (4.5 pages)