Essays on Reimbursement

Symptomatic treatment or palliative treatment refers to therapies that relieve symptoms, without correcting the basic or underlying cause of the disease. Symptomatic treatment of pain normally aims at reducing the pain but not to eliminate the disease causing the pain (Eliopoulos, 2013). The society normally reinforces or promotes symptomatic treatment of pain rather than correction of the underlying problem through several ways. One is self-management, whereby patients do not seek professional help but rather attempt to manage pain on their own or with help of family and friends in order to prevent flare-ups (Eliopoulos, 2013). They can do so ...

Introduction

Operation performance of the organization influences significantly the satisfaction of the patients and the financial progress of the hospital. Evaluations of the metrics that determine the operation performance in the healthcare are critical in determining the quality of the healthcare given by the hospital to the patients and the influence of the quality of the healthcare to the satisfaction of the sick and to the financial performance of the clinic. The leaders of the Healing hand hospital had realized value-based quality of healthcare was the key driving aspect in the healing industry. Determination of the performance of the clinic ...

Question 1

The three types of reimbursement methods are traditional methods, prospective payment systems (PPS), and Fixed Payment. In particular, the traditional method is a payment method based on the submitted charges (Corro & Robertson, 2011). On the other hand, the fixed method of payment based on fixed payments made monthly. Moreover, the PPS reimbursement method composes of three methods of payment: Diagnosis Related Group (DRG), Ambulatory Classification of payment (APC) and a value scale related to resource based (RBRVS).

Question 2

The advantages of the traditional payment method include first the approach of payment gives researchers of healthcare information on how the patient ...

Managed care is an essential system of delivering health care across the country that works towards the provision of a generalized structure necessary to focus on the use, access, effectiveness, quality, and cost of services offered. The management aspect creates a link to the patient, which deliberates on the provider services noted across the industry. Two main modes of managed care provisions include provider reimbursement as well as hospital reimbursement aspects. Working on these aspects requires a premium understanding of issues within the community. Provider networks attempt to reduce costs that emanate from providing better fees for the services ...

Diabetes in America: Research Proposal

Given the recognition and on-going research into the disease of diabetes, there has probably been thousands and perhaps millions of books and articles written on the subject. The most commonly recognized types are type 1 and types 2 diabetes, but others include gestational, monogeneic, and cystic-fibrosis related diabetes (NIDDK, 2017). It is impossible to determine how many people in the world have diabetes or how many will develop it. The estimates of the amount of money spent in patient care and research are only guesses, and the suffering by diabetes and their loved ones is incalculable. However, this paper ...

Introduction

The term managed care refers to various healthcare insurance plans used in the United States, which are aimed at moderating the cost of providing care to the citizens. Essentially, the techniques used are intended to enhance the quality of patient care provided in the medical facilities. The approaches also include the systems of financing the enrolled organizations under the managed healthcare concept and techniques. In this essay, three types of managed care plans will be discussed. Furthermore, their impact on the way services are delivered at Healing Hands Hospital will be included. The paper will identify the changes that ...

Article Summary

Insigniam: Ten Disruptive Forces in Healthcare The article articulates the factors that are perceived as disruptive in the healthcare sector. Part of the discussion includes transition to value-based reimbursement, which turned hospital systems into a healthcare system by providing pre-emptive care. In addition, the system is currently shifting volumes and lower reimbursement in order to reduce cost while maximizing the utilization of all systems. Another important areas of concern in healthcare are when the system moves from caring for the sick to focus on primary care. This issue is related to the prevailing increase in government regulation where agencies ...

Q. 1: The article discusses the role of a sales manager in the relationship selling process. This is achieving by exploring the five critical components that entail management of the relationship selling process. The performance of a salesperson is examined in the article based on the perspective of the manager and the salesperson. Role perceptions and motivation are termed as the key elements in management of salespersons in an organization. The recruitment and selection of a sales force in an organization is investigated in one section of the article where the objectives of sales training and various training techniques ...

Assignment 1A

Ivan T. Formality

Dear Sir, I am Xyz the employee of WTF and been working since last two years in the marketing department. I have decided to take ENGL 4091 Business Writing and avail the company’s college tuition reimbursement program. Could you please consider my request and approve the college tuition reimbursement that improves my knowledge and education level? I am writing this to get your permission for taking ENGL 4091 Business Writing. I want reimbursement after successful completion of the course as per company policy. The course will help to improve my business writing skills and knowledge. ...

Hershey and O’Rourke (2009) argued that the CMS reimbursement changes on “never events” had not only payment implications but also affected the liability risks of inpatient healthcare providers whether there was involvement of the federal payer or not. As a result, the inpatient care providers had to adopt new strategies in the mode of service delivery in the institutions to avoid liability. Some of the shifts in the patient care delivery model include the following. Inpatient providers have increased precautions when handling “never event” complications that have led to an improved safety culture associated with the high-reliability organizations ( ...

Health Care

Under conventional repayment protection, the cash takes after the patient. Patients select human services suppliers and visit them as they pick. Suppliers at that point charge the private guarantor or open payer and are repaid on a charge for-administration or per case premise. This is known as Managed Care. The key issues associated with Managed Care are: I) Cost Savings II) Provider Reimbursement and III) Quality of Care . Cost Savings: Savings done by Managed Care are either not genuine, or are unsustainable. In a late review of shoppers, 60% said that managed care had either not had any kind ...

Abstract

The creation of a employee benefit plan will be crucial to the start and retention of a business. Providing employees with benefits that are important to them will attract talented individuals, and ensure the business goals and strategies are met. Some of the most significant components of an employee benefit plan include wages, insurance and time off. Each of these components relates to the compensation of an employee, and employee compensation is what attracts, retains and motivates individual employees. Without an adequate plan, a business would not succeed. An employee benefit plan must be comprehensive and requires a plan ...

Abstract

In healthcare financial management, health insurance contributes in determining the healthcare services. The fee schedule provides a list of charges reimbursed for service providers and suppliers. Center for Medicare services, CMS, uses the fee schedule to determine the facilities and non-facility in healthcare provisions. Physicians, ambulance and medical equipment services among others help in the determination of the fee schedule by Medicare Physician Fee Structure (MPFS). The study focuses on CPT code 99214-office visit as the reference in the service delivery by the center of Medicare services. The Medicare and Medicaid rates are essential in determination the fee schedule. ...

It has been said that if someone finds a job that he loves, he never actually has to work a day in his life since the job is so enjoyable and rewarding that it hardly feels like work. This idiom resonates with me because I believe that embarking upon my chosen vocation or calling for a tangible portion of my life will be challenging, rewarding, and enjoyable. As determined as I am to pursue the career of my choice, human resources manager, I understand both that I will need help achieving my objectives and that I will need to ...

Executive Summary 3

Introduction 4 The Workforce as a Competitive Advantage 5 How to Value and Retain Employees 7 Proper Recruitment Strategies 7 Staff Socialization 8 Training and Development of Staff 8 Compensation and Rewards 9

References 12

Executive Summary All the resources of an institution are crucial in the development and achievement of the objectives of a given business entity. It is essential for the management of an institution to properly manage the resources. However, the human capital is regarded as the most vital resource of an institution. Its skills, competencies, knowledge, and innovativeness, are essential in the growth of human resource management. ...

Chapter 2: Literature review

Introduction This chapter presents the literature review appraisal that exists and is linked to work contentment and inspiration subjects and how these issues are closely related to industrial performance. The chapter discusses the concept of motivation, job satisfaction, and project management and employee satisfaction. Organizational performance as well as its continuity largely depends on critical assets, employees and the managers' capabilities to create and sustain motivating environments of the employees and other human assets. The primary challenge that managers are faced with today is keeping their human capital such as the employees satisfied and motivated. Therefore, all managers must ...

Executive summary

Introduction It is apparent that the modern-day healthcare system is faced with a myriad of challenges that require constant and relentless application of evidence and best practices in order to remain true to the central mandate of healthcare, which is, provision of safe and quality care. This implies that as healthcare providers, there is the obligation to be agents of positive change that would ensure both organizational and healthcare objectives are met in an effective and comprehensive manner. In this regard, this paper represents an executive summary of quality improvement program “fall prevention”, intended to reduce the number of ...

Introduction

Healthcare is an integral part of a nation’s well-being. Despite its importance, there has been an increasing trend in the costs of health care. With the current high national debt, health care reimbursement should be part of the equation ("Healthcare Reimbursement | Knowledge Hub | athenahealth", 2016). The policy makers, physicians, and patients are well aware of the steps they need to take to reduce the costs of health care by considering health insurance plans. The insurance policies enable the doctors and other health practitioners to provide quality and efficient health care to the people. Health insurance payers are provided ...

Abstract

In 2009, the US government slashed Medicare reimbursements pushing over two-thirds of health care providers into losses. Medicare reimbursements are expected to increase in the future albeit more slowly than the rise in the cost of providing quality health care. The challenge for BSA is to be able to align its costs in a way that they are able to deliver quality health care at a much lower cost. The key is to measure both the cost and the outcomes of the health care. There is need to establish an accurate system of measuring costs, as well as to ...

Abstract

The healthcare systems comprise of many services that can lead to the successful delivery of treatment to the patients. Patients can receive their treatment and then the member or the hospital can contact the third party payer to reimburse them. There are numerous reimbursement methods and clients chose one that they. The methods include; the Value-Based Purchasing Medical Reimbursement, pay for performance, fee-for- service and episode-of-care payment. Each method has both its advantages and disadvantages to either the patient or the hospital. An acute care hospital which provides quality treatment to the patients within a short period utilizes the ...

Diabetes is a chronic illness characterized by absent or reduced pancreatic production of insulin and decreased cellular sensitivity to insulin. The result is a rise in blood sugar levels which does harm to body tissues. Obesity, or a body mass index (BMI) of 30 or greater, accounts for up to 85% of an individual’s risk of having type 2 diabetes (T2DM), which is the more common type (Eckel et al., 2011). Statistics show that obesity occurs more in older adults with more than a third of adults 65 years old and over considered obese (Eckel et al., 2011). ...

Abstract

The Helicopter Emergency Medical Service (HEMS) industry plays a crucial role in developing an industry approach to risk management in the area of air medical transport. The aviation sector has been known to manage risk at very high levels, but the current state of HEMS, given the many accidents, needs higher level risk assessment. An analysis of the risks involved in the HEMS industry would allow operators to maximize their opportunities and minimize probable threats. While some risks are uniform to most HEMS operators, there are some risks that are unique to an operator. For this paper, Air Methods ...

Importance of Identifying Sources

Importance of Identifying Sources of External Funding To Support Nursing Research The lion share of the conducted investigations is performed with the funds, which are issued by the sponsoring agencies. The core purpose of such funding is to provide the monetary support for the researchers and for their training in the set of different agencies. In order to get the funds, the principal investigators (PIs) or the researchers should submit their proposals to the corresponding sponsors (Gray et al, 2013). This may be done via the particular institutions, supporting the research or by the means of requesting the funding ...

Introduction

Good governance and capital structure play a crucial role in the maximization of corporate profitability, either through an increase in profit margin or a reduction in capital cost or both (Uwuigbe, 2014), and in effect shareholders’ wealth. Companies who are aware of these factors in their objectives of profit maximization eagerly put their good governance principles into corporate codes, which act as valuable reference points in their governance decisions. As such, sound corporate governance engenders investor confidence in terms of capital preservation and acceptable returns of investments (Okiro, Aduda, & Omoro, 2015; Agyei & Owusu, 2014; Heng, Azrbaijani, & San, 2012). With ...

Problem Solving- Scenario One

Problem Solving- Choosing between completing college and taking up a job.

The problem present here is a choice between two options; college education or a job. The new job is out of state which in turn means that to take up the job. I would have to quit college. The job offers attractive benefits including car, housing, and relocation allowances besides an attractive remuneration. The current job does not offer college fees reimbursement but supports my present studies. I am nearing the completion of my studies and nearly taking my last exams, which would be cut short, should I ...

The EBP process is accomplished to the fullest when the recommendations and the evidence are utilized to cause a change within the organization. The EBP process is the interplay between research, education and practice and therefore forms a core for the implementation and adoption of change within an organization. It is the process that offers a viable plan to accomplish a change in respect to a particular research question or problem that has been identified within the setting (Dearholt & Dang, 2012). EBP is concerned about the specific interventions to a specific situation based on tangible evidence and data as ...

Introduction

Undeniably, the cost of the Healthcare system in the United States has been increasing rapidly. Despite the introduction of Affordable Care Act (Obama Care) in 2010, the Americans continue to face a rising cost of medication. In fact, according to the report on 2015 healthcare provider outlook, the U.S health care expenditure is likely to increase to about 17.9 percent of GDP by 2018, making health be the largest sector in the U.S economy (Healthcare provider’s outlook United States, para 1). In this paper, we analyze some of the major facts on U.S healthcare system. Next, the paper ...

Elderly care facilities provide services in the fulfillment of the special needs and requirements that are unique to the senior citizens. They are also called residential care facilities for the elderly or assisted living or sometimes referred to as ‘board and care’. Primarily, they are non-medical facilities that provide housekeeping, meals, supervision, storage and distribution of medications including personal care assistance with basic activities. Eldercare is a broad term that encompasses services that include assisted living, long-term care, adult day care, nursing homes, hospice care and home care (Saul, 2013, p.79). It emphasizes the social and personal requirements of ...

Medicine

2016-05-16 The revenue cycle management in the healthcare industry can be considered as managing of claims, payments and revenue generation. A special medical billing software is needed in order to effectively keep track of all business processes (especially, claims tracking). There are twelve main steps for managing company’s revenue cycles (McKesson, 2016). Let’s describe them in more detail. Physician ordering is the first step. It belongs to the pre-visit part of the revenue cycle management. During this step staff should receive information about eligibility and confirm it. Patient registration is the next step of the pre-visit part. ...

The current shortage in the number of registered nurses in the US is expected to increase to more than 500 000 registered nurses by the year 2025 (MacKusick & Minick, 2010). The current nurse turnover rate in the United States, on the other hand, is 16.5%. This rate is also projected to rise over the next decade (Mazurenko, Gupte, & Shan, 2012). High rate of nurse turnover is one of the factors contributing to the nursing shortage in the US. It is estimated that 30%-50% of all new registered nurses change their positions or choose to leave the profession completely ...

The Patient Protection and Affordable Care Act (PPACA) usually referred to Affordable Care Act (ACA) and nicknamed Obamacare is a U.S federal bill that was signed into law in March 2010 by President Barrack Obama, it is the latest healthcare transformation law that seeks to enhance quality and accessibility of healthcare services to all Americans (Ornstein, 2015). The PPACA empowers consumers to be in control of their own healthcare by giving them the flexibility of making well-versed choices concerning their health; this is provided for in the ACA under the Patient’s Bill of Rights (Levy, 2010).

Stakeholders in evolution of Affordable Care Act

Many stakeholders ...

The struggle to access affordable and quality care has been a challenge to many citizens in the United States for quite long. Many reforms in the healthcare system which have been carried out in the past from the President Clinton to President Bush administration did not managed to provide sustainable solutions to many Americans who were grappling with the high cost of health care and failing economy. However, the President Obama administration has tried to bring to sanity in the health care system and some relief to consumers. The promulgation of the Affordable Care Act of 2010 made it ...

Innovation in Health Care

Abstract This paper explores innovations in healthcare and the barriers involved. Research includes the trials of political and managerial influences and how they promote or delay the execution of innovative health care. The benefits of innovative healthcare will be outlined as well as the challenges faced through barriers on many levels throughout business and political operations. Ultimately, the paper is in favor of innovative healthcare and advocates to enrich the reader on the overall importance of effective and rapid innovation in the medical sector. The paper also explores the weak points of the American health care system and references ...

Medical billing is an iterative process that involves the translation of a healthcare service or product in a billing claim. Ideally, the medical biller has the responsibility to make sure the healthcare institution receives sufficient reimbursement for the services provided by the medical practitioners. The responsibility of the biller may vary from one institution to the other based on size and capacity of the healthcare facility. Ultimately, the medical biller must have specialized knowledge regarding medical records and just like the medical coder; they must have strong familiarity with ICD-9-CM, CPT and HCPCS level II codes (Smiley, 2012). Most ...

Executive Summary

Implementations of care paths will/may help cut healthcare costs. This report argues that the adoption of the care path approach is necessary to ensure MGH's costs are sustainable, but to ensure success, a phased approach to implementation approach, stakeholder engagement, constant, communication, and use of formal change management models will help.

Summary of the Case

As one of the largest hospitals in the country and a pioneer of open-heart surgery, MGH its ability to rein the costs of one of the most expensive procedures would serve as an important guide for the rest of the industry. Its costs are higher than its competitors ...

Introduction

Owing to the fact that policy implementation is essential to the development of a company, Turner Constructions needs to embrace an influential ethical decision making framework. This is largely accredited to the fact that the current system is rather inefficient and is not centered towards the welfare of the employees. The current system does not ensure equality in the employee compensation due to the wide salary margin between field engineers and project managers $54,522 and $130, 893 (Payscale, 2016). Additionally, the newly employed personnel do not get a good conducive environment for growth due to the inadequacies of ...

Impact of ICD-10-CMS/PCS on MS-DRGs

Introduction Procedural and diagnosis codes, as well as their associated descriptions, play an important role in numerous health care processes. For instance, both hospitals and the Centers for Medicare and Medicaid Services (CMS) rely on coded information to help run primary care activities. Such activities include reimbursement management, care optimization, and population health monitoring among others. As this happens, there is a need for constant technological changes and upgrades to facilitate accuracy and completeness in data transmission. The recent movement from the ICD-9 code set to ICD-10 is a perfect example of such upgrades. This paper shows that the ...

Databases Worksheet.

Question 1: The difference between database types and capacities. Databases are organized collections of digital data. There are various types of databases such as document-oriented databases designed to store, retrieve and manage semi-structured or document oriented data. Graph databases use a graph data structure with nodes, edges and attributes to represent and store data. Hypertext database types are used to organize large collections of disparate data such as online encyclopaedia content. Finally, the relational database type stores data in forms of rows and columns (tables) and are most commonly used (Aizel, 2012). Database capacity refers to the memory and ...

Anthony

The most preferred method would be the "greater than highest payer’s reimbursement method." I like the idea of it being a "step back tool" to take a look at the overall costs of all the services provided and dividing up what insurers will pay and compare it to the costs. A good example of this would be when a patient comes in for a service like a MRI and their insurance wouldn't allow them to go to St.Luke's due to the costs of doing it there versus another company like Metro Imaging, which would be cheaper for the ...

Third Party Payer Newsletters

Human life is a constant movement forward on the path of development. It is possible to say that life is a constant process of expanding new boundaries, achieving the best results, self-development and personal growth. And in this process, one of the dominant roles is played by the issue of the meaning of actions and deeds, which are made by people. The process of development could be observed in the organizational activity. To achieve the goals of the organization, management should ensure effective action among its personnel. To do this, it is necessary not only to provide a functional ...

Question 1: Ensuring compliant coding and billing

Adhering to accurate coding and billing processes is one of the most important elements in ensuring RCM coding and billing compliance. A critical process that can be used to ensure RCM practices comply with coding and billing regulatory guidance and industry standards is regular monitoring and auditing of medical claims before submission for payments such as the ICD-10 standards (CureMD, 2016; Kochhar, n.d.). Frequent request follow-up and verification activities improve and strengthen the overall coding and billing processes of a firm by helping ensure that all the necessary right safeguards are in place to avoid errors (MetricStream Inc., 2016). ...

One of the most significant tasks managed by Health Service Administrators is managing the legal and regulatory issues that face healthcare, and health care providers. Leadership is called upon to ensure that these legal premises are followed, in order to protect patients, health care providers, and health agencies alike. Ann Smith, CEO UK Healthcare was tasked to explain some of the leading legal and regulatory issues which impact the delivery and management of healthcare. She indicated that the most prominent issues listed in no particular order, from a legal standpoint, facing health service administrators include the application of HIPPA, ...

Introduction

There is a high likelihood for the developed countries such as the United States, Australia and Canada among others to attract immigrants who are looking for a place where they can have a better life. However, the trouble is that, many of these immigrants do not follow the right procedure to get in to these countries. Taking the case of the United States, this country is facing a problem of illegal immigration because people, for instance, move in to the country illegally across the U.S-Mexico border, or they enter the country and stay for a longer time than required. Currently, “the United States ...

Inpatients can defined as the patients who are confined in an institution like a hospital or a nursing home for a temporary basis and where they stay overnight. An Inpatient admission begins when a hospital formally accepts a patient who is to be given health care services while being accommodated at the facility. When it comes to inpatient admissions, it is the responsibility of the physician who is admitting to determine those patients to be admitted in the hospital and ensure that the admitted person is monitored by hospital staff to ensure that there is proper documentation (Scott, 2006). The Centers for Medicare ...

Risk is inherent in all characteristics of a commercial procedure; equally, for banks and financial organizations, credit risk is a necessary issue that requires handling. Credit risk is the likelihood that a borrower will fall short in meeting his or her responsibilities in conformity with contracted terms. Credit risk, consequently, occurs from the bank’s transactions with or loaning to business, persons, and other financial establishments. This area of credit evaluation and measurement is enormous and every new account fronts new tests. When an application is obtain, what does a financier searches for in it? Answer to this is not merely comprehensive but ...

1. Overview

The Methodist Healthcare is the second largest not-for-profit hospital in the United States of America. With a string of seven hospitals, multiple home health agencies and numerous outpatient clinics serving the Mid South under its name, the Methodist Healthcare has had it all. In 2011, Methodist has been ranked number 35 among the Top 100 Integrated healthcare networks by the nation’s leading heath care rating system (SDI) (Memphis Business Journal, 2011). The Methodist healthcare offers the following areas of specialty; the transplants institute that major with services of pancreas, kidney and liver transplant. The Neuroscience institute in collaboration with ...