HS440-04: Finance for Healthcare
Unit 2 Assignment: Third-Party Payers
Professor Zacharia Varughese
January 18, 2015
To the attention of the Board of Directors of Health Care Systems, Inc.:
As the CFO of Health Care Systems, Inc., I feel like, in order to have proper reimbursement, correct coding is very important. If the codes are wrong, the charges will be wrong, as well. When you submit codes, the federal government uses them to reduce health care fraud. It is always good practice to double check your numbers before you submit them. “So, knowing the difference a diagnosis code of 280 (iron deficiency anemia) and 820 (a fracture of the neck of the femur) will help protect your practice from fraud and…show more content…
These regulations give the necessary guidance to charitable hospitals. These statutory regulations are as follows:
“Limit charges – hospitals can’t charge individuals eligible for financial assistance more for emergency or other medically necessary care than the amounts generally billed to patients with insurance (including Medicare, Medicaid, or private commercial insurance).” (Takagi, 2014).
Establish and disclose financial assistance policies – this must be done by each hospital to describe the eligibility criteria for patients needing to apply for financial assistance and what methods are available.
Abide by reasonable billing and collection requirements – they can’t engage in some methods of collection, like garnishing wages, unless it has been determined that the patient is not eligible for financial assistance.
Perform a community health needs assessment – the assessment must be done every three years or so. It must be entered on tax forms that are filed each year. “Third-party payers are the insurers that reimburse health services organizations and hence are the major source of revenues for most providers.” (Gapenski, 2013). Third-party payers feature three parties. The first party is the patient or the person that is responsible for paying the bill. The second party is the doctor and/or any healthcare organization that is