Physician Reimbursement

“The amount people pay for health insurance increased 30 percent from 2001 to 2005, while income for the same period of time only increased 3 percent.” (Source: Robert Wood Johnson Foundation). The rising cost of healthcare is a huge problem in America today. In this paper I will analyze the different issues and causes for the increase in cost.

There are many factors that have influenced the changes of health care economics. Money and technology has definitely been the reason for the change of health care economics over the years. Money is want makes the economy evolve. There will be advancement in technology and there needs to be people are managing these to keep up with the changes. The U.S. has definitely progressed as far as influencing factors to change in new advancement of technology and medical care. Having a good financial manager in your organization will prepare for these upcoming advancements and changes. Money drives these advancements in

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.

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

Healthcare spending growth rate trends show astounding estimates. Since 1960, spending has risen from $27 billion ($143 per capita, 5.1% pf GDP) to amazing $1,678.9 billion ($5,670 per capita, 15.3% of GDP, 2003 data) (HHS, 2005). Recent research estimated that by 2013, healthcare spending will be as high as 18.4% of the Growth Domestic Product. It is important to note that the gradual move from hospital to ambulatory setting has resulted in much higher spending on outpatient hospital services and prescription drugs. The spending growth for these two trends is much higher than the overall healthcare cost growth, which, in fact, increases faster than such important economic indicators as GDP growth, inflation growth, and population growth rates.

The following paragraphs will discuss the methods and effects of reimbursement in the U.S. healthcare system, which party bears the financial burden, issues of moral hazard and cost control mechanisms, and the role of government regulation in the healthcare market.

The Centers for Medicare and Medicaid Services is a government agency within the U.S. Department of Health and Human Services. The CMS is in control of certain health care programs. Reimbursement is used in the healthcare field by coding specialist in hospitals and physicians’ offices. These specialists assign appropriate diagnosis and procedure codes based on the patients’ individual medical record. Once the information from the patients’ record is coded, a bill or claim is composed and sent to a third-party payer for the reimbursement of the services that were performed on the patient. Depending on the payer, they may request that a copy of the patients’ medical record be sent with the claim.

The government influences the delivery of healthcare by setting forth several different requirements. As with any state or federal agency, licensure of both the facility and providers are required (Gartee, 2011). In addition, there are certain standards that must be met by the facility in order to participate in government funded programs. The most widely known programs within the healthcare industry are Medicare and Medicaid.

The outcome is that many low-income adults and other Medicaid beneficiaries continue to suffer from pain and discomfort of tooth decay and gum disease. Eventually, at some point, patient may need to go to expensive emergency rooms, where they can do little but provide temporary pain relief. Consequently, untreated oral diseases can increase anxiety and may worsen other health problems, such as heart disease, diabetes and rheumatoid arthritis (Choi, 2011).

“The biggest problem with health care is not with insurance or politics. It is that we are measuring the wrong things the wrong way” (Kaplan & Porter, 2011, p. 46). Total healthcare expenditures and expenditures as a percentage of GDP have been considerably higher in the U.S. Hospital care, physician and clinical services, and drug prescription expenditures have been the principal components contributing to growth in healthcare expenditures in the U.S. compared to other countries. The study also analyses and compares the growth of healthcare costs. Three different perspectives on the health care “cost crisis” are understanding the value of health care, most health care costs are fixed and healthcare cost covered by health insurance program. In this paper share ideas to help solve the cost crisis in healthcare.

Health care is a huge added player in the hat rides the Current national expenditure levels in the United States has more than tripled in the past decade, while the amount of Americans that can afford private health insurance has dropped and the number of people relying on Medicaid and Medicare has increased with the aging baby boomer generation. Medicaid and Medicare being two of the governments most used medical insurances, the spending in health care has grown faster than the economy can bear. The Medicare physician reimbursement system provides a kind of “public good” for other insurance programs; that is, it offers a

I too find myself thinking about the non-compliant patient and how they will impact our reimbursement. For so long the mindset of many Americans has been, we can do what we want and the doctor will fix it or give me a pill. There has been no sense of accountability for personal health among a large portion of the population.

The reimbursement method that I will discuss is Fee-for-service (FFS), which services are unbundled and paid for separately. This health insurance plan allows the holder to make almost all health care decisions independently and gives an incentive for physicians to provide more treatments for more control over person’s care. The FFS has align the interests of providers and patience to submit a claim to the insurance company, and, if the service is covered in the policy, receives reimbursement. Fee-for service plan has been contributing to the rising healthcare costs because the financial incentives are so embedded in this model as a crucial part of the health care system. The Fee-for-service plan was especially useful as the employee wanted

United States spend a lot of money on healthcare: for instance, the cost of the office visit, hospital stay, even prescription drugs every year. Lawn states, “….. Those in our audience who work in healthcare know the cost of providing care to the indigent and uncollectible is top of mind for every healthcare administrator” Lawn, J. (2009). Physician received a substantial amount for an office visit through Medicare and Medicaid. Therefore, one of the best ways to cut prices on healthcare is by embracing low-cost primary cares.

Health prices are collected separately for people with health occasions for those who maintain at being knowledgeable, but yet still old fashioned with those individuals having activities with different types of causes have a quantity of expenses afterwards. Physician’s deals with all types of money requested (“safekeeping”) for those who are responsible for their actions. Frequent expenses made by physician’s deals with all types of money actions that are frequently changed every day for completeness. This expense is changed frequently to complete by the physicians. Guesses has charges that are pending, but not always established. Contributors’ name: Yong, P.L. (2010). The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Retrieved by: https://www.ncbi.nlm.nih.gov/books/NBK53906/.