Nonmembers Case Study

With the conditions provided in the promotion, they will be paying $115.54 each month. If they do not pay on time they will be charged a fee and will be required to pay $152.54 the next month.

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

Third party – Reimbursement payments made by an insurance company that provides benefits for the

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

This insurance encouraged people that had this basic form of insurance to get a second opinion on their medical issues especially elective surgeries. You had to pay for services that you were receiving right away.

|  Re-imbursement for the insurance. If the paper work is not right it will affect billing and can create major problems.

|Indemnity Plan |Able to choose hospital and doctor, Fee for service, deductible, |Individuals and Families |

Fee for service indemnity plans are essentially health insurance plans in which the consumer may choose any provider or hospital that they want to use; however, these plans are typically more expensive than other plans (Mukherji & Fockler, 2014). The fee for service plans pay only for services rendered, typically using the CPT coding system (Reimbursement, 2016). The indemnity plans will require the provider to bill the insurance company for services rendered (Zuvekas & Cohen, 2016). Typically, the insurance company will pick up 80% of the patient’s bill and the patient is responsible for the other 20% (Zuvekas &

A direct reimbursement plan might pay an employee100 percent of the first $150 of fees that can cover preventive care and possibly radiographs. Whereas in indemnity plans an employer must pay upfornt the high premium before insurance coverage for preventive services for all employees. With direct reimbursement, there is no need to worry about major services being covered at 50 percent, or restorations at 80 percent, because direct reimbursement does not divide dental treatment into categories such as basic dental services, major dental services, and orthodontics in traditional

For this facility they have to pay the premiums directly or it will either way rediced from their pensions directly.

Fee-For-Service or Traditional Indemnity plans are uncommon but still used. Payment is rendered for services provided. Traditional Indemnity plans in general have no provider network and a patient can see a specialist without a referral. If a patient uses an FFS plan, the patient would pay the provider for medical care provided. If the medical care provided is covered by the plan. The insurance company would then reimburse the patient according to the guidelines stated in the policy or the UCR’s “Usual, Customary, and Reasonable Fees.” (“Private-Fee-For-Service Plans,” CMS.gov, 3/16/2012). Key benefits of a Traditional Indemnity or Fee-for-Service plan include no in network physicians or health care providers and the patient may see any physician or seek health care services at any healthcare facility. The patient or client can also seek treatment from a specialist without a physician referral. Fee-for-Service plans are the most flexible plans for choosing a healthcare provider and health care facility. However, Traditional Indemnity plans are traditionally the most expensive plans offered by Health Insurance companies to customers. Insurance companies typically will not reimburse one hundred percent of the amount paid out of pocket, deductibles must be met by the patient before co-payment or reimbursements are issued by the insurance company, and the patient is liable for all payments out of pocket until reimbursement is issued.

Finance is a key internal factor that impacts this business. The largest portion of this company's incoming finance is insurance. Patients are typically responsible for a co-payment amount but majority of the patient's bill is paid by insurance. If a patient doesn't have insurance, they are considered Self-Pay and

Optional Credit insurance is used to show what coverage the member/ joint member has chosen for their loan.

In order to strategically meet the needs of the Board I would choose the following four new Board nominees: Peter Skylar, Charles Wong, Sue Novenski and Carmen Diaz. The hospital listed their needs and each of the nominees would be able to contribute to the hospital and create the environment that would work to its benefit. Listed in the order of preference to join the Board the nominees each had the following qualities that would assist in the major goals.

The KHMH have patients who have insurances covered by different insurance companies within Belize. In the case of these patients, the insurance pays 80% of the bills and the patient is responsible to pay the final portion of 20%. The collections unit at the KHMH stays engaged with the insurance companies and solidifies their relationship by keeping in communication to ensure smooth payments of bills. They also take advantage of the third party insurance which stipulates that in the event of traffic accidents, the bill must be covered by the insurance