Using The Reimbursement Model, And The Wage Payment Model

In the famous Belmont Report, several guidelines regarding informed consent, assessment of risk and benefits, and selection of subjects in addition to ethical practice and procedure in the area of human research are outlined. The Belmont Report attempts to summarize the basic ethical principles identified by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (Belmont Report, 1979). In particular I would like to discuss the standards for informed consent, assessment of risk and benefits, and selection of test subjects drawn out by the Belmont Report. These three areas of interest are said to be the applications of the general

Unit 2 AssignmentKelley WhitcombKaplan UniversityHI215-01: Reimbursement MethodologiesProfessor Kathleen SobelJuly 20, 2015Medicaid is one of the biggest insurance plans you can get in any state. In the state of Indiana, it is based off of your income. There is a certain amount (income) you have to make to determine if you will receive Medicaid or Healthy Indiana Plan (HIP). HIP is still a form of Medicaid, but you would have to pay monthly cost for it and have certain set of co-pays for certain services that is needed. HIP Plus is the recommended plan for members as it provides health coverage for a low, predictable monthly cost. HIP Plus also covers dental and vision services. If you do not pay your monthly payment you can be removed from

It is unethical to compensate study participants in research studies. In the book called, “The Immortal Life of Henrietta Lacks,” by Rebecca Skloot, she discussed how the ethics in this circumstance is unanimous and not questionable. Before Henrietta Lacks died from cervical cancer in 1951, a doctor cut out tiny samples of her cancer cells, which will soon become the first and most important human cells to continue to multiply and survive in the laboratory. The problem was, is that they used Henrietta Lack’s tissue without her consent. In the medical field, it was important and a great benefit to all human kind. It was extremely unethical and without the consent of Henrietta and her family, this lead to many questions of the morals of the

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.

In “Taking the Least of You”, Rebecca Skloot combines medical stories from different people and how they were either positively or negatively affected by allowing researchers to use their bodily samples for research. She discusses the use of consent, ownership, legality, and ethics. In each individual case she discusses. One man named Ted Slavin allowed his blood samples to be used for research to create a Hepatitis B cure. He signed a consent form that gave his blood to research, but he also made sure that he could get legal compensation from the research. However, a man named John Moore was different. He allowed the researchers to use his samples for research, and when he found out they were worth billions of dollars, he tried to get awarded

Additionally human medical research studies often targeted those who came to public teaching institutions desperately seeking free medical treatment and who generally looked up to doctors and experimenters as experts in the field who were there to help them. While this motivation may seem logical, it is often faulty as many human medical research studies throughout history demonstrate that the motivation of medical researches is often not the care of those currently suffering from a particular condition but the future returns on the cures or medical treatments that may be discovered during the study (McKie). As with many such unethical studies, the participants often do not give consent and are not informed of known dangers to the procedure, medications or lack of treatment. The use of individuals who are poor, uneducated, and lack medical insurance in combination with prestigious university research institutions and the white coated, well-educated researchers motivated by discoveries of cures on the scientific frontier results in abuses of individuals.

The United States health care system has can be assessed for quality measures in many different ways such as mortality rate or infant mortality, but the United States government often judges the efficiency of health care provider or network on the Centers for Medicare & Medicaid (CMS) core measures. The reason the United States gauge health care performance on CMS standards is due to CMS is the federal governing body that operates Medicare and how the hospital will be reimbursed from Medicare patients. Formerly Medicare would reimburse a hospital based all services the hospital provided a patient or fee for service (FFS). The rising

The key elements to a healthy and successful medical practice are a reliable and properly trained staff and a sound revenue cycle that produces satisfactory reimbursement. Revenue cycle management starts at the front-end with pre-registration of the patient. Complete and accurate recording of patient insurance and billing information is imperative. Insurance verification plays a major role in the assurance of reimbursement. The front desk should counsel and confirm financial responsibility with the patient during the registration process. Patient encounter is equally as important. Correct coding of patient diagnosis and procedures minimizes the likelihood of claim rejection. The next step in the revenue cycle is claim submission. The claims process begins with the provider treating the patient then sending a bill to the designated payer. Before the bill is sent, a certified coding specialist or medical billing specialist prepares and reviews the claim for any inaccuracies. There are a few ways the claim is submitted, either manually or electronically. Once the claim is submitted, follow-up with third party payers is a necessary step in the

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.

I think that reimbursement system is one of the most important implements to maintain managed care organization. However, there are various models accessible to manage hospitals or health care associations to keep track of reimburse payment methods. As of carefully reading through the book, I believe a basic model of reimbursement includes Fee for services, capitation, and salary. However, each of these models is states differently and approached it differently.

To descripe the reimbursement model for todays US healthcare market is to say it is fragmented and complicated. The government accounts for 64% of the US healthcare market, followed by private insurance companies, and self-pay (Self-funded plans, or cash). This fragmentation causes a lot of confusion, as each plan can have many different payment systems within itself.

There are many medical practices, facilities, and agencies have found that nurse practitioner (NP) and physician teams are key to providing high-quality and cost-effective care. After working diligently in providing patient carte there must be a reimbursement such as a fee-for-service. There are many entities like the public, private and managed health care plans that may regulate the reimbursement processes or each state. The public insurance costs less than private insurance is that payment rates for health care providers are typically lower. Another aspect to understand in what differentiate those types of payers the private insurances do not offer dental or vision care, services that are important for children, and some low-cost private

Direct reimbursement is a plan that “involves direct and unlimited reimbursements” as long as they are allowed and reasonable (Johnston & Marshall, 2009, p.379). This plan allows the sales manager a little “control over both the magnitude of sales expenses and the kinds of activities salespeople will be motivated to do” (Johnston & Marshall, 2009, p.379). Moreover, direct reimbursement will allow sales reps to take possible new accounts to lunch to try to get their business (Johnston & Marshall, 2009). By allowing sales reps to get direct reimbursement on expenses it will stimulate the sales reps to use it (Johnston & Marshall, 2009). The sales rep has to turn in receipts and justify the expenses before they can be reimbursed (Johnston & Marshall,

There are many ethical issues in the healthcare field. These issues range from insurance coverage, senior care, childhood immunizations, beneficence, abortion, medicinal marijuana, honesty and medical research (Fritzsche, D., 2004). Today we will discuss the ethical concerns in only one aspect of heath care and that topic is research (Benatar, S., 2000). Medical research is necessary in order to make strides in health care, introduce new medications, to discover new symptoms and disorders and to test new treatment options for current medical problems. Students of medicine, universities and pharmaceutical companies conduct this research primarily. Much of this research is time consuming and costly, therefore obtaining funding is not

Thousands of people voluntarily enroll in clinical drug trials every year. They are putting their health and safety at risk by participating in a drug trial. One would think they would be doing this to promote medical advancement, but in all actuality, it is for the high dollar amounts they receive for compensation. People that frequently enroll in drug trials are often called “guinea pigs.” The monetary amount people are paid can go as high seventy-five hundred dollars. The more invasive the procedure is the higher the compensation. These “Guinea pigs” are required to pay taxes on the money they do make. (Elliott, 2008)