Brooke Army Medical Center Case Study

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

It is essential for an administrator to understand how private and government payers impact actual reimbursement. Government payers have a standardized benefit structure. The one benefit is that registration staff have an easier time calculating payment due (copayments) for service and can set up payment arrangements. Since the most significant proportion of funds coming into a healthcare organization is usually payments from third-party payers, therefore, it is critical to know how each reimbursement affect the others that come in. Healthcare organization may have hundreds of different payer’s relationships in the form of different contracts that have their own rates of payment that are usually different from other payers for an identical

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

Obtaining reimbursement for services provided is a necessity for the survival of many health care organizations. This paper will explain, in my opinion, why the Centers for Medicare and Medicaid Services (CMS) are involved in this development and how it affects the American public. I will offer a suggestion to ensure meeting policy and procedure. I will finish by discussing three ideas listed on the CMS website.

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.

Amy holds a bachelors degree in accounting and has worked in the medical billing field for over twenty-five (25) years. Her exhaustive knowledge of reimbursement coupled with her attention to detail has been essential in servicing new and existing clients. Her leadership and knowledge, has in every aspect of the revenue cycle

Through the history of health care, the standard of care changed from protecting our patient from injury and illness to a systemic entity to make money for insurance companies. Access to services and clinical outcomes are dependent on what health insurance providers will “pay” for in a clinical or community setting; as a result, patient safety, care and satisfaction has been negatively impacted.

Jones Regional Medical Center is a huge academic health center with 900 beds and are known for its research and teaching hospitals. Additionally, the IT staff at Jones supports 300 applications and 12,000 workstations. The center uses Technology Med (TechMed) for their admitting system. The system includes registration, inpatient charge, payment entry, master patient index, admission, hospital billing, and more. The TechMed system has been accessible since 1998; Jones is beginning to plan a replacement of this systems because of the fragility of the software (Wager, 2013).

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

Based on the political and economic environments of states and the federal government the methods of health care reimbursement have been required to evolve. With the introduction of the Patient Protection and Affordable Care Act (PPACA) new laws have been set into place that has caused a stringent review of spending on health care. All care provided is being examined for effectiveness, quality, and the actual need of the service. Unnecessary health care functions are being screened and eliminated. The government and other insurance providers have begun to place cost containment measures in place only paying for those procedures that are deemed medically necessary for the illness that the patient is currently afflicted with. This has a direct impact on the monies that the government and insurance providers will reimburse for services. The following paper will look at the major types of reimbursement activates currently in place. The writer of this paper will also speculate on the future of health care reimbursement and how it will affect his current organization.

In the case of Shahine vs. Louisiana State University Medical Center, the plaintiff Ms. Shahine experienced right ulnar nerve damage following a right total hip arthroplasty. She filed suit against the University Medical Center and her anesthesiologist, Dr. W for medical malpractice and requested the court to infer negligence under the doctrine of res ipsa loquitur. Dr. W was fully responsible for Ms. Shahine’s care while she was under anesthesia and Ms. Shahine obviously could not assess the true cause of injury while she was anesthetized. However, Dr. W provided evidence of non-negligence by thoroughly charting in Ms. Shahine’s medical record proper positioning and padding. Another anesthesiologist provided the court with uncontroverted

Start the restore process which would involve contacting the appropriate technical support staff, explaining the problem to the technician.

Tulsa Memorial Hospital (TMH) is one of the nine acute care hospitals that serves in the general population area. Historically, it has been highly profitable due to its well-appointed facilities, excellent medical staff, good-standing reputation for quality care and its ability to give individual attention for each of its patients. The hospital, in addition to its inpatient services, operates an emergency department and an urgent care center located two miles from the hospital across the street from a major shopping mall.

If you are interested in this position please answer the following questions. We will review your responses and if you qualify we will begin setting up interviews. Please have your responses returned to me within the week of your receipt.

The Hampton VA Medical Center Primary Care Service recognizes _________________ for their outstanding service. Mr./Ms.____________ performed beyond expectations to ensure that our staff and veterans needs were addressed. For their efforts, I am pleased to recommend a contribution award of $2500.