The Legal Aspects Of The Health Forecasting Course Essay

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.

The delivery of the U.S. healthcare system has changed drastically over the years from the inception of organized healthcare to today’s underdeveloped system. Prior to the 1920’s,

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

I believe I have become more cynical over the years of being in health care and going through this course has not helped that very much. I often think to myself “Why am I in a customer service oriented job?” The entitlement people expect is mind blowing. However, I also think that my perception of health care is growing positively because of the different class and subjects that have been touched on throughout this course. I have a better understanding of the process it takes to get a law passed in our government, how to outcomes, and how to design a facility floor plan. Health care is changing quickly with the Affordable Care Act (ACA) and the amount of patients with the ability to get medical care. The amount of providers was not increased to help handle to large increase in patients. Patients are struggling to make appointments in a timely fashion because of the increased volume of calls on the call centers or front office staff. Patients are waiting longer periods of time to get an appointment because of the increased volume of patients. Doctors have the ability to not be enrolled as a provider in health care plans and that limits the availability of doctors that are able to treat patients on Medicare and Medicaid.

In this country there are numerous concerns about health care economics. Several factors contribute to the increase of health care costs. One area of concern is the impact of managed care on health care finances. Managed care has been around since the early 1970s. The definition of managed care is a set of contractual and management methods implemented to manage the financing and delivery of health care services. Initial implementation of managed care was for health care cost saving (Getzen & Moore, 2007, p. 203, para. 1). Though Managed care initially addressed several health care finance issues, there are still problems with the current

The HCS 405 week 1 financial terms worksheet throws light on some of the most basic concepts of the healthcare business. Understanding health care financial terms is a prerequisite for both academic and professional success. The health care business helps the nation by providing the building blocks that the citizens need to live a successful and healthy life. The worksheet is intended to ensure that the students understand some of the basic terms used in the business world of the health care industry. The purpose of HCS 405 individual and team assignments is to make the students aware about the numerous strategies employed in the financial and other departments of a

Obtaining reimbursement for services provided is a necessity for the survival of many health care organizations. This paper will explain, in my opinion, why the Centers for Medicare and Medicaid Services (CMS) are involved in this development and how it affects the American public. I will offer a suggestion to ensure meeting policy and procedure. I will finish by discussing three ideas listed on the CMS website.

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.

Over the past fifty years, the method in which healthcare services are funded has gone through significant changes. The country has seen the expansion of insurance from paying medical bills for hospital stays, to the creation of managed care, and the passing of the Affordable Care Act (ACA). While the process has not been without challenges, healthcare administrators must continue to analyze past funding systems to understand the oversights and misinterpretations to prevent complications in the future. This paper will investigate fee-for-service practices and how these practices have progressed to uncontrolled utilization.

The method in which healthcare services are funded has gone through many changes over the past fifty years. The country has seen the expansion of insurance from paying medical bills for hospital stays, to the creation of managed care, and the passing of the Affordable Care Act (ACA). In order to prevent future issues with financial options for healthcare services, healthcare administrators must analyze past funding systems to understand the oversights and misinterpretations. This paper will investigate fee-for-service practices and how this practice led uncontrolled utilization.

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

In an attempt to understand the impact of managed care in the U.S, I look at the most commonly expressed complaints against the organization. In a survey of consumers, 60% said that managed care had not made a difference in health care cost or had actually been the cause of the increase of health care cost. Managed care has had an impact on slowing the rates of growth in the costs of two major health care producers: hospitals and physicians. Little evidence has suggested that the current reimbursement are inadequate to the care provided. The quality of care is a highly debated issue. Physicians are concerned that the quality of care in managed care organizations may reflect the loss of professional autonomy through pre-authorization procedures.

Managed care was born out of necessity. It involves plans, members, providers, and payments intertwined, one not working without the other. With managed care came rising health care costs. Utilization management and quality initiatives were introduced to help control these costs. Medicare and Medicaid were also helpful in setting standards of care which reimbursement is based on as well as providing access to health care for more people. Health care costs continue to rise but with passage of the Patient Protection and Affordable Care Act (ACA) the goal is more people will have access to affordable, quality health insurance while reducing the growth in our healthcare spending.

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.

The strategic management process is based on the belief that businesses should continually monitor internal and external events so timely changes can be made. To survive, firms must be able to identify and adapt to change. This involves timely planning, directing, organizing and controlling of the strategy-related decisions and actions of the firm (Camerer, 195-219).