Health Care Co-Pay Analysis

Our Healthcare system is clearly business based according to the article “Cost Conundrum” and on the movie “Escape Fire”. In the movie it had an impacting story of an older lady who had heart problems where she went to a doctor and they were going to charge her thousands of dollars were later she went to a different doctor and they charged her a couple hundred dollars for t he same procedure. I couldn’t believe that in a different office she would get the same procedure done for a lot cheaper than in the other doctor’s office. Also, it surprised me how the medical staff are giving all these medications to our soldiers were they are clearly

With the implementation of the ACA, many states have expanded their Medicaid programs to include a larger population of low income individuals and families that were not able to obtain health insurance prior to the law. Some of the issues that state legislators struggle with are the overall cost of providing services for the additional recipients, staying within budget, determining an adequate approach of offering quality care, and providing adequate coverage for each recipient. Even though the cost of Medicaid expansion within each state has increased the budget for the program, new appraisals has shown that Medicaid programs spend less per enrollee than commercial health insurance and much of the increase in Medicaid expenses originate from the increase in enrollment in the programs (Coughlin, Long, Clemens-Cope, & Resnick, 2013).

The Affordable Care Act (ACA) was signed on March 23, 2010 by President Barack Obama. The enactment of the ACA accounted for medical reform throughout the United States (Osmonbekov, Yordy, & Gregory, 2014). The provisions of document were all geared towards enhancing healthcare by lowering the costs, creating new consumer protections as well as improving access to care. Some of the provisions include section 2706 which establishes nondiscrimination in healthcare. Further, section 4001 provides national prevention, public health council, health promotion as well as an advisory group on prevention and integrative medical issues. The above provisions affect acupuncture practitioners in various ways.

The Affordable Care Act has drastically changed reimbursement (and subsequently patient care) for better and worse. While healthcare has become more accessible, quality of care and doctor-patient interaction has decreased. Statistically, hospitals have seen an improvement in compensation, but this doesn’t include private practice and outpatient centers. Government-run healthcare is slow healthcare, and to make up for this physicians have to work faster and longer. My mom’s work as a physical therapy assistant has her working 10-12 hour days in the off season months of summer, and my own work as a secretary at her office opened my eyes to the consolidation of providers to get better reimbursements, which leads to fewer private practices. While

A highly motivated and dedicated analyst with over two years’ experience in start-up Research Office at Huron Consulting Group. Working on developing Medicare Coverage Analysis (MCA) and study budgets for clinical research protocols in various therapeutic areas such as oncology, cardiology, pediatrics, and internal medicine for multiple clients across the country. A meticulous eye for detail in assisting clients with mitigating clinical research billing compliance risks, by interpreting and applying Medicare/Medicaid coverage decisions and national care guidelines to determine correct billing to insurance providers and research study sponsors. A confident communicator with an emphasis on utilizing the strengths of colleagues and creating an

On July 30, 1965, Medicare was signed into law by then President Lyndon B. Johnson. The President declared “No longer will older Americans be denied the healing miracle of modern medicine (Johnson, 1965). The Medicare act was implemented to provide the older population of U.S. citizens and those with disabilities and end-stage renal disease with financial security, coverage, and access to healthcare. It’s a federal program that most families will eventually rely on. “As the single largest purchaser of medical services in the United States, Medicare is an important source of income for hospitals, physicians, home health agencies, and other medical care providers” (Oberlander p. 119).

Clinical business intelligence is a modular and scalable platform that helps the organizations to seamlessly integrate data from multiple clinical and financial system and address the most critical BI and analytical needs. Physicians use the hospital EHR and other clinical IT applications to make decisions and provide excellent care to the patients but recently the physician practice network deployed new EMR along with a bunch of online e-prescriptions and lab applications. The hospital system relates to a statewide health information exchange. The new kinds of data support the physicians and administrators in making clinical and financial decisions. BI clinical also leverages technology partnerships to give organizations the

Medicare focuses on medical acute care such as doctors visit, hospital stays and drugs. Also, it focuses on short-term services such as physical therapy after a fall or stroke (U.S. Department of Health & Human Services, 2013). Medicare covers services for long term care such as short stay in a skilled nursing facility, home heath services and hospice/respite care, but it does not cover costs for personal/custodial care such as help with bathing, dressing, eating, etc.. In 2015, Forbes reported that Medicare will pay for some of the costs only if a patient meets the following conditions:

The first improvement in health care made by Affordable Health Act of 2009 is it has reshaped the health care system in terms of access by making it easier for those who couldn’t afford it, were out of the age range, or had preexisting conditions by making new rules to include them. It has also reshaped the health care system in terms of quality be ensuring that the payment to health care providers does not out way patient care. “To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement” (Lopez, 2013). Another improvement made by the Affordable

Through the formulas we can manage resources and revenues which is what chapter 15 explains about. At the beginning of this chapter it brings about the subject of healthcare insurance which protects the individual from “paying the full price of healthcare” (Sayles and Gordon 2016) and also the Affordable Care Act which is more commonly known by its nickname Obama Care. There are a number of ways a person can ways an individual can pay for such insurance is by out of pocket which means that the money for the procedure is coming straight from the patient and copayment also called co-pay which ‘is a cost-sharing measure in which the policyholder pays a fixed dollar amount per service. All of this depends on eligibility which pertains to the verification

You have made a lot of good points about the impact of deductible and co-payment on patients seeking health care. Did you know that 51.1% of low-income families reported have to delay or forgo treatment due to cost of care compared to 34.8% of higher income families? Based on this finding it was suggested to policymakers that deductibles be set based on income and family size. (Anonymous, 2010)

Often, when an individual is buying their own plan, the premiums are very high and are not able to be met. Some of these people who cannot afford premiums on their own do not qualify for government funded programs either. Many of these people are left uninsured or under-insured. Health insurance programs have started to increase deductibles. Cost has become an increasing issue with the current ACA, as well as quality for these government funded program’s patients, caused by the physicians contracted to provide care to these individuals.

More than 30 million people who were previously uninsured now have the chance to be covered and more patients means more healthcare jobs for medical professionals looking for work. Now there are over half of uninsured people that can get low cost or free health insurance, some Americans can be assisted on out-of-pocket costs using their state’s Health Insurance Marketplace. There are now more private coverage options than ever, and all major medical coverage options must provide minimum essential coverage. ObamaCare’s many protections ensure that you can’t be dropped from coverage when you get sick or make an honest mistake on your application. You also can’t be denied coverage or treatment for being sick. Also, you can’t be charged more for

President Donald Trump announced last week that his administration will no longer make cost-sharing reduction payments, which have helped nearly 6 million low- and moderate-income Americans afford the health care services and medicines they need. The Affordable Health Care Act requires health insurers to reduce consumer cost-sharing requirements, such as deductibles and co-payments for enrollees who earn between 100 percent and 250 percent of the federal poverty level. The administration's decision to end the cost-sharing reduction payments not only disrupts the health insurance market, but contradicts many of the health reform priorities expressed this year by both the president and members of Congress.

The mandatory benefits that Medicaid insurance is federally required to cover include: Inpatient and outpatient hospital services, early and periodic screening, diagnostic and treatment services, nursing facility, home health and physician services, rural health clinic services, laboratorys and x-rays, family planning, nurse midwife, and freestanding birth center services, certified pediatric and family nurse practitioner services, and medical transportation (Goldman, 2005). Along with the mandatory requirements, there is also a list of optional benefits that many states are using to expand Medicaid. These optional benefits include: prescription drugs, physical and occupational therapy, speech, hearing and language disorders, respiratory care, podiatry and optometry, dental, prosthetics and eyeglasses, chiropractic, personal care, hospice and private nursing services (Goldman, 2005). States also have the option to charge premiums and establish out-of-pocket spending for Medicaid enrollees (CMCS, n.d.) These out of pocket costs can include co-payments and deductibles. However, certain groups including children and pregnant women, are exempt from most out of pocket costs. States can also charge a higher co-pay when Medicaid enrolled individuals visit a hospital’s emergency room for a non-emergency service (CMCS,