Health Care Reimbursement

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Health Care Reimbursement 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. Health Care Reimbursement Activities One method of reimbursement aimed at controlling costs is the use of diagnosis-related groups (DRG). Medicare uses the DRGs to place inpatients into one of over 1000 categories based on the medical condition citied for admission. This is a prospective payment system that shifts the responsibility to the provider for more cost efficient care. For
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