The Benefits Of Healthcare Billing

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

While this is an area of concern, I also believe that processing the patients at the registration desk is a task that could be virtually eliminated altogether. Simply by requiring patients to register online and scan or fax documents by a predetermined cutoff time, staff members could complete this process without interruption and have the necessary information already in a file when the patient arrives.

There has been discussion to have universal healthcare system similar to Medicare as a method to have a centralized monitoring system of cost. There have also been other systems tried beginning with HMOs in the 1970s in an effort to streamline access to necessary healthcare services by employing a gatekeeper to their access at the primary care levels. With patient dissatisfaction, PPOs were tried which circumvent the necessity of referrals (Hacker, 1998). Either of these models had substantial effect on healthcare outcomes while the cost of healthcare continued to skyrocket. The US spends more than any other country on healthcare but outcomes are not better (Blackstone, 2016). In 2010, under President Obama’s leadership, Affordable Care Act was passed and one of the promising features is the formation of accountable care

Chapter five from the text Health Policy the organization, financing, and delivery of Health Care in America third edition by author Donald Barr M.D., Ph.D, confirms healthcare’s complexity. The text describes many healthcare, competitive options. Each time a health dilemma has arisen instead of repairing the current health care model, the government develops a new plan. Healthcare plans are similar to software upgrades. Each time a technological glitch occurs the software manufacturer creates an update of the previous version. Most often the software update is another expense for the consumer; not a viable option. Furthermore, the upgrade does not guarantee the new version will work any better. Typically, there is yet another glitch to fix in the latest version. In essence, the health care system should problem solve the healthcare plans that have failed.

“Health care spending in United States has been increasing in fast growing rate. As compare to 1980 when the health care cost was $256 billion. It has been increased now with $2.6 trillion in 2010. The cost was increased by tenth times from the past. The major driving forces behind it are following. Increases administrative cost also fueling the overhead cost and one of the major contributing drivers of health care spending as it is the 7% of all the cost spend on health care.” (Bluegrass, 2013). The cost to manage the system has been increasing as the demand for health care benefits. Expenditure on healthcare is increasing as the population demand and number of disease increases. It needs the increased expenses on administration as well.

Anthony, I do think this court case represent the “aggressively” proactive preservation and accuracy that those in oversight of Medicare billing and schedule fees have take towards even slightly unacceptable billing practices. These investigative techniques and strong enforcement clarify that those who providers who participate in Medicare are solely responsible for making sure their billing practices are verified and accurate in accordance with Medicare participation standards. It is clear that there are people within the system that try to take advantage of Medicare’s payment guarantee such as this case I found regarding a fraud bust in resulting in 46 doctors and nurses arrested, and overall 243 people were arrested in 17 cities that accounted for $712 million in Medicare fraud. Here is how they implemented some of their fraudulent billing to Medicare by “Sometimes fraudsters, known to the Feds as ‘patient recruiters,’ will go to places like homeless shelters and soup kitchens and offer money to those who would share their Medicare patient numbers, a Department of Justice spokesman said” ((Lobosco, 2015).

Users requiring medical care, typically will find the nearest facility providing the services they require, and must contact the clinic to initiate an appointment request. Once the individual has arrived to attend the appointment, instead of promptly receiving care, the individual must fill out many forms to meet the protocol that all patients must be expected to complete. Research from the International Journal of Computer Science and Information Security Research, studied the lacking functionality of the current healthcare system, the authors studied the effectiveness of a mobile program.“The current system is

Sixty percent of the population has private health insurance, which pays for a third of health care spending [1].Majority of the administrative costs responsible for higher medical costs in United States are attributable to private health insurance[2]. The estimated percentage of of health care dollars spent on administration is between 20% and 30%. These administrative costs are largely related to marketing underwriting,sales commissions,administrative functions,net additions to reserves, premium taxes and profits [3], processes that do not improve medical care. The numerous private insurance plans in the similar geographic locations is causing Hospitals to negotiate payment rates separately with each payor, thereby increasing health care providers’ costs by making processing complicated and time-consuming. Thus,inefficiencies have been raised due to billing and insurance related activities leading to a waste of billions of dollars which are paid by consumers and employers in the form of premiums to private insurance companies. The costs of insurance administration in the U.S. health care system totaled nearly $156 billion in 2007, and that figure is expected to double—to reach $315 billion—by 2018

Medicare is the nation’s largest health insurance program which benefits to more than 40 milliion Americans. However, billing and administrative fee overly cost that Medicare will soon can not handle the fee which leads to the disruption of health care in the U.S. The Medicare reform, various choices for Medicare and reduce fee-for-service plan are proposed to ensure Medicare program to continue. Medicare reform must be contained by injecting economic efficiency into the program, realigning the economic incentives of those who demand medical goods and services and those who provide them. Reduce fee-for service seems to be easy but not since there are many fees and charges should be taken care of in the form of insurance providers. While Medicare

Balance billing is when the physician was able to bill the patient for any additional balance that was left over after Medicare paid. In order, for this to happen the patient needed to pay the full co-payment the doctor wanted and then submit a form to Medicare to reimburse them the amount they would have paid. This increases the financial risk with a Medicare patient because most Medicare patients can’t afford to lay out the full price of the co-payment right then and their, so they don’t pay their doctor bills. By not paying their doctor bills, they are gaining more debt in their life. Also the patients that can lay out the money can forget to submit the form and don’t receive their reimbursement. By doctors using balance billing, it can

· Patient Registration: As soon as a patient calls in to set an appointment with the provider they have effectively pre-register with their doctor’s visit. If the patient has seen the doctor before which then is established patient he or she needs to give the reason for the visit. If the patient is a new patient then they have to provide personal and insurance information to the provider to ensure them eligible to receive services from that provider.

In 2001, Consumer-Driven Heathcare plans were introduced (wall street journal ref) Consumer-Driven Healthcare plans (CDHP) can be combined with Health Savings Account (HSA), Health Reimbursement Acocunt (HRA) or Flexible Spending Accounts (FSA). The idea of conjoining the two assists the consumer with paying for their deductibles, by using their HRA, FSA and HRA’s. The idea of utilizing Consumer Driven plans is to help decrease unnecessary claims and allow for more health consensus individuals. CDHPs were develop to assist in the rising health care costs and provide individuals with control over their health care endeavors.

Managed care was established in order to manage health care cost, utilization, and quality (Kongstvedt, 2015). In managed care, health insurance is provided through HMO, PPO, and other types of managed care. It has the potential to reduced health care spending and improved the quality of care. However, despite of its success in improving the quality of care through preventive health care services, chronic disease management program, and so forth, many physicians are reluctant to be part of the managed care environment. Some of the reasons are the impact of managed care to physician’s income and autonomy. Under managed care, insurers have decreased the fees paid to physicians. There are different ways how managed care organizations control costs. One of this is through selective contracting with health care providers and hospitals to lower costs. In selective contracting, health care providers agreed to accept lower prices in exchanged for guaranteed volume of patients under managed care plan (Culyer, 2014). This paper will discuss more issues and trends in Managed Care Organizations such as the rise of Medicaid Managed Care spending, the new Medicaid Managed care Rule, and the collaboration of Managed Care Organizations and Accountable Care Organizations to reduce health care spending and improve efficiency of care.

Because we have not received notification from you regarding the remaining balance under your Medical Payments Coverage, we are closing this portion of the claim. You have 3 years from the date of loss listed above for bills incurred on your Medical Payments Coverage for injuries relating to this motor vehicle accident.

The website of VRH on World Wide Web is another efficient tool used for interacting with patients and ensuring their satisfaction. It was created as the hospital established in order to update useful and necessary information for anyone interested in using its service and simplify all procedures for patients. The site uses the latest Web 2.0 technology with friendly tools so that patients can register for diagnosis as well as make dates and consulate with doctors online (T.T.Nguyen, personal communication, March 28, 2011). According to the hospital’s policy, if customers register online before they come, they will save their time by not having to stay in queue and wait (T.Nguyen, personal communication, March 26, 2011)