The Health Care Financing Administration

Both Medicare and Medicaid are administered through a division of Health and Human Services called the Centers for Medicare and Medicaid Services (CMS).

The United States (U.S) healthcare system is a large private system that consist of multiple payers, which leaves the U.S

The first characteristic of the US health care system is that there is no central governing agency which allows for little integration and coordination. While the government has a great influence on the health care system, the system is mostly controlled through private hands. The system is financed publically and privately creating a variety of payments and delivery unlike centrally controlled healthcare systems in other developed countries. The US system is more complex and less manageable than centrally controlled health care systems, which makes it more expensive. The second characteristic of the US health care system is that it is technology driven and focuses on acute care. With more usage of high technology,

The Centers of Medicare and Medicaid Services (CMS) is a branch of the United States Department of Health and Human Services

In order to more fully delve into this issue, this literature review will be focusing on three main areas of study as it applies to the topic of Medicare/Medicaid reimbursement and its relation to the Affordable Care Act. These areas of focus will include

Health insurance in the United States is not a single nationwide system and is much more diverse in terms of production methods (Ridic, Gleason & Ridic, 2012). Health insurance is either purchased privately or provided to some public groups from the government, mainly Medicare and Medicaid (Ridic, Gleason & Ridic, 2012). Medicare is a nationally run program for aged and disabled individuals (Ridic, Gleason & Ridic, 2012). Medicaid provides coverage economically disadvantaged groups (Ridic, Gleason & Ridic, 2012). The Affordable Care Act of 2012, established a shared responsibility between the government, employers and individuals ensuring all Americans have access to affordable health insurance (The Commonwealth Fund, 2016). For private

The terminology (i.e., Federal health care programs) contains any program that provides medical benefits, even if directly, by means of insurance, that is paid directly, in full or in part, by the US Government (i.e., Through programs such as Medicare, Federal Employees Health Benefits Act, Federal Employees’ Compensation Act, the Longshore and Harbor Worker’s Compensation Act) or any State health plan (e.g., Medicaid, or a program receiving funds from block grants for social service plan requirements. Guidelines, an industry should have

The Medicare and Medicaid programs were signed into law on July 30, 1965 by president, Lyndon Baines Johnson. The Centers for Medicare & Medicaid Services (CMS) is an agency within the US Department of Health & Human Services in charge of administration of several key federal health care programs. CMS is responsible for health care programs such as, the Health Insurance Portability and Accountability Act (HIPAA), the Clinical Laboratory Improvement Amendments (CLIA), and the Children’s Health Program (CHIP) amongst other services.

The U.S. health care delivery system is very complex because it is not a universal health system governed solely by the federal government. Only Americans with health care insurance coverage receive routine health services. Health insurance can be purchased in the private market or provided by the federal government. The uninsured and poor population acquire health insurance by government funded health care called Medicare and Medicaid. Medicare and Medicaid is the largest payer of health care services in the United States with Medicaid providing health services to about 72.5 million and Medicare provides health coverage to more than 55 million (CMS, 2015).

The Center for Medicare & Medicaid Services (CMS) is the largest federal health insurer body which provides healthcare services in the US. CMS must ensure that their beneficiaries have access to high-quality care.3 This mission becomes even more

The United States currently employs a multipayer system. The payers in this system include the government and private insurance companies., thus the collection of money for health care is a joint responsibility of both parties. Private insurance companies collect premiums and other payments from enrolled individuals and businesses. The government collects taxes from individuals and businesses. Regarding reimbursement, the private insurance industry reimburses providers for health care services delivered to privately insured individuals, while the government reimburses providers for health care services delivered to publicly insured individuals (e.g. people enrolled in Medicare, Medicaid, S-CHIP, or the VA).

Today, the United States health care system is basically funded by a combination of public (Medicaid and Medicare) and private insurers. There are numerous private companies that provide insurance plans for companies

The three principle parties involved in the U.S. Healthcare system are the consumer, provider and insurer. The provider includes the hospitals, clinics, doctors, nurses and pharmacies that provides a service; the consumer is the individual who receives the medical service and supplies the money; and the insurer is a third party intermediary between the provider and the consumer which accept money from a pool of consumers and reimburse the providers. Like any transaction, there is a certain degree of risk associated for members of the different parties. This risk is based upon variables within the U.S. healthcare model including the method of, and who is reimbursing the providers.

In todays’ healthcare most people with private insurance today get coverage through their employers. Public programs provide

Reimbursement is costs or repayment for health care benefits. In the United States health benefits are often provided before the payment is made. End result physicians, clinics, hospitals, and other health care contributor establishment request reimbursement for health services provided in addition to expenses incurred. Presently reimbursement of claims for healthcare service depends on the appointment of medical codes to explain the diagnosis.