Advantages And Disadvantages Of Out Of Pocket Payment

The U.S. Department of Defense has required Brooke Army Medical Center to seek reimbursement for medical procedures conducted on third party insured civilian patients. The need for a professional billing service to effectively acquire third party reimbursement for healthcare services within Brooke Army Medical Center is essential to the financial success of the organization. The hospital is operating in a demanding environment due to a highly regulated healthcare industry and an uneven playing field compared with other local community hospitals. Nearly one-third of the nation’s hospitals demonstrated operating losses in 2014 with Brooke Army Medical Center being no exception. Additionally, uninsured patients are costing U.S. hospitals $900

A mixed payment system combined with physician monitoring, will provide physicians with incentives to consider costs and benefits of different treatment options, which will lead to an efficient level and quality of care. (1,2)

Recently, a Consumer Driven Health Plan (CDHP), was created. There are many variables to a CDHP, such as benefits covered and coinsurance amounts, however there is one thing that all CDHP’s have in common – a high deductible. By having a high deductible, such as $1,200, it forces the plan participant to think about the medical services they are seeking. Do they really have to go to the emergency room for that cough or can they go to urgent care, or better yet, their physician the next day. When the plan

1). Private health insurance is another way of paying for health care. The associated costs of health care are offset according to the policy the person has purchased. Private health insurance costs are paid by premiums, deductibles, and co-payments from the insured person. There is also the portion of people who are uninsured and are considered self-pay patients. These uninsured patients represent a large part of unpaid services. Although, not all uninsured patients leave bills to be absorbed by the health care system many do, and this increases the costs of health care to be absorbed in other areas.

Regrettably, there is a downside of High Deductible Health Plans (HDHP), and that is the likelihood of higher expense later on if there is any cataclysmic medical issue with you or your family. With a High Deductible Health Insurance Plan, you run the risk of having higher out-of-pocket expenses. For example, a major medical issue warrant surgery, you would have to pay your deductible before the insurance company pays anything. This may cause you to forgo crucial health care needs; due to the high-deductible and out-of-pocket expenses you would occur. Lastly, if your monthly out-of-pocket expenses are high, this will enable you to have an advantageous use of your health savings account (HSA).

Unit 2 AssignmentKelley WhitcombKaplan UniversityHI215-01: Reimbursement MethodologiesProfessor Kathleen SobelJuly 20, 2015Medicaid is one of the biggest insurance plans you can get in any state. In the state of Indiana, it is based off of your income. There is a certain amount (income) you have to make to determine if you will receive Medicaid or Healthy Indiana Plan (HIP). HIP is still a form of Medicaid, but you would have to pay monthly cost for it and have certain set of co-pays for certain services that is needed. HIP Plus is the recommended plan for members as it provides health coverage for a low, predictable monthly cost. HIP Plus also covers dental and vision services. If you do not pay your monthly payment you can be removed from

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

| Most American receives their health coverage through the private insurance market, usually through their jobs. Many people buy insurance on their own in the individual market. Since coverage from private companies is the largest surge of insurance for Americans it is likely to be a central part of federal and state health reform efforts. Private health coverage is a mechanism for people to protect themselves from the potentially extreme financial costs of medical care if they become severely ill,

Another issue for fee-for-service system is that the providers set the prices for services. Patients were free to seek any type of healthcare services that they thought they required, while providers set the costs for each service that was billed to indemnity insurance companies (Shi & Singh, 2015). Insurance companies had little control on the types of services that the patient received and prices billed for each service. The fee-for-service model encourages excessive and unwarranted procedures and offers no incentives to utilize economical services (Smith, 2010). While the patients enjoy the freedom of being able to seek out their own services, over-utilization of expensive services on unnecessary and highly technical services increased healthcare costs.

Healthcare reimbursement systems within the United States are a complex structure for obtaining payment for services rendered. The healthcare system officers are required to understand the ordinary principles of the payer system. Understanding the rules, and keeping up with the continuous changes will allow the providers, physicians, and facilities to gain an advantage in this growing healthcare domain. Both private and commercial insurance companies provide a diverse menu of choices to customers. All third-party payers create interest in decreasing healthcare costs and improve control access to the not needed services. This paper will address the complexity of the healthcare reimbursement systems in the United States. Additionally, the research

The goal of the initiative is to increase efficiency of care, improve quality of care, and lower costs. This initiative consists of four different bundled payment models. The first three bundled payment models are retrospective payment arrangements based on patients’ historical data. However, the fourth model is proposed for the future. Centers for Medicare & Medicaid Services (CMS) make a single bundled payment to the hospital for all services during inpatient stays for hospitals, physicians, and other medical professional specialists.

However, the most common way used worldwide is with payroll deductions, very similar to how it is done in the U.S. In our country most people pay for healthcare insurance by having the cost deducted from their payroll check and often their employer matches the deduction in some way. In those other countries that use payroll deduction instead of the money deduced from the payroll going to an insurance company the deduction goes to the government healthcare system (Berk, 2007).

Understanding the classification of healthcare services in terms of acute and long term care enable us to plan for services, to describe institutions, and to allocate funding and reimbursement. In the United States, healthcare services provided by health care providers (such as doctors and hospitals) are paid for by the following including, private insurance, Government insurance programs, people themselves (personal, out-of-pocket funds). Additionally, the government directly provides some health care in government hospitals and clinics staffed by government employees. Examples are the Veteran’s Health Administration and the Indian Health Service.

There was a time not so long ago when a doctor would make house calls and had a modest private practice. People did not have to worry about calculating the medical costs as the doctor would only charge what he knew someone could afford and would allow payment arrangements to be made. With this type of service, the doctor was more concerned with the quality of care provided as opposed to just getting the patients in and out.

There are two broad approaches to financing health care: a market-based approach and a government-financed approach. For each approach, answer the following questions: