Health providers are dependent upon payment for the provision of their services regardless of whether patients or an insurance provider provides them. It is vital to understand how the MHA FPX 5006 Assessment 1 Health Care Finance and Reimbursement can help you become an effective leader in health care. Medicare, Medicaid, and Managed Care are the three types of income sources that I will be discussing.

Medicaid

Medicaid is a federal income-driven program subsidized and supported with state money and is available to those who are in or fall within the scope of assistance from the public, in addition to seniors who have exhausted their financial resources. Medicaid covers around 20 percent of the population that is not elderly and is the biggest health insurance company, following health insurance policies provided by employers. (Harrison and Harrison 2012). A review of the Medicaid official site, which is accessible to all members of Colorado states. As of October 2022, Colorado had registered 1,670,835 individuals who were enrolled in Medicaid and CHIP. In previous posts, I’ve emphasized the truth that Medicaid is funded by the federal government in addition to the state level. That’s the reason that the federal government needs to offer states a particular amount of money to cover its costs. It is also known in The Federal Medical Assistance Percentage (FMAP) that states are required to make sure they have sufficient funds to cover their portion of Medicaid charges to cover health and medical assistance provided through states’ Medicaid program. ( Finance Management Medicaid, n.d .).

MHA FPX 5006 Assessment 1 Medicaid is the most common fee that covers all the services provided, and it is usually lower than the actual costs of these services because of the lack of funds to pay. It is vital to ensure that service providers utilize correct procedures and diagnosis codes to avoid rejection of claims. If the amount isn’t present or correctly entered in the diagnostic code, the claim may be rejected, resulting in the service provider forfeiting all profits earned by the process. Medicaid is subject to Medicare guidelines regarding covered procedures. The amount of reimbursement is based on Diagnosis Related Groups (DRGs). These details can be found in the Medicare section.

Medicare

Medicare A is described as an insurance plan that covers hospitalization fees for individuals aged sixty-five or more and under 60 who suffer from permanent disabilities. Medicare A is a policy that will pay for the first 60 days of an inpatient hospitalization after coinsurance and deductibles have been paid, as well as charges for skilled nursing services (Moody 2021). Part 2, which is included in Medicare, includes Medicare Part B, which pays for expenses that aren’t included in Part A in the same way as services that are provided outside of hospital facilities and using medical devices that are long-lasting (Harrison and Harrison 2012). MHA FPX 5006 Assessment 1 medicare A beneficiaries who are in Medicare A have to make a contribution of around 20% of the costs for their medical services. Medicare provides around eighty percent.

As per Medicare, billing procedures are established by listing codes and diagnoses. Medicare is a payment-per-service program that employs DRGs that are based on a specific diagnosis, which can be either primary or secondary. It’s possible they can be dependent on gender and age. DRGs are DRGs that are given to patients who are hospitalized and are determined based on the reasons for hospitalization. There are approximately 25 different treatments that can impact the same DRG, and patients may receive several DRGs at a single time.

MHA FPX 5006 Assessment 1 Health Care Finance and Reimbursement

The DRG can change as the patient’s health declines over a period of time. DRGs calculate costs by analyzing the average of visits made over the last. It’s not an incredibly complicated procedure, but that’s not the case. Healthcare professionals sign contracts with Medicare to pay an agreed-upon price for their services. If the company is paid $ 3,000 for outpatient costs, Medicare will only pay about $550. However, the business is expected to “eat” the remaining. A good example of an expense to cover inpatient treatment can be a business that charges $5000 for the treatment of pneumonia. Medicare cannot provide 2.3 days.

The average is about $2000 per day, approximately $4600, which the hospital might be able to. It is one of the primary reasons hospitals are able to receive. Hospital administrators get themselves into the middle because they’re obliged to shift beds to generate profits. However, it is illegal to discharge patients ethically until they are able to allow it. There are a few protocols and procedures that require prior approval before they are allowed to take place in any way. If the approval cannot be received, the hospital will be rejected to receive reimbursement. The hospital is.

The benefit of this policy for businesses is the fact that they are confident they’ll be compensated for their services. It’s merely an issue of cost. Patients are able to take advantage of being covered by insurance, which is acknowledged by almost every healthcare provider, which results in savings on their out-of-pocket expenses when compared with those who do not have insurance.

Managed Care

Managed Care (HTML0) is a type of insurance that includes preferred provider organizations (PPOs) and Health maintenance companies (HMOs). In the case of PPOs, the payer will typically be an outside party, usually an insurance firm that negotiates lower-cost plans with primary care doctors along with specialist hospitals (Harrison and Harrison 2012). MHA FPX 5006 Assessment 1 Health Care Finance and Reimbursement policies do not allow patients to choose among their doctors due to the insurance coverage that is covered by the policy. If a patient chooses to visit a doctor who isn’t part of the insurance network, the company is in a position to refuse coverage of services or provide a less expensive cost for treatment.

Another type of managed care is capitation, which is provided by HMOs and reimburses healthcare providers monthly a certain amount per insured regardless of the amount of healthcare services required by those covered. Under this arrangement, the principal healthcare providers must examine patients for medical issues, and they are capable of directing patients to specialists if needed. HMO plans have the lowest monthly membership costs. However, they limit the number of physicians and healthcare providers (Harrison 2012 as well as Harrison 2012).

Conclusion

Whatever revenue source the business chooses to use, regardless of the source, the department’s finance director must be aware of the appropriate methods to ensure that your business receives the greatest benefit from the services it provides.

References

Colorado | Medicaid. (n.d.). https://www.medicaid.gov/state-overviews/stateprofile.html? state=colorado

Financial Management | Medicaid. (n.d.). https://www.medicaid.gov/medicaid/financial- management/index.html

Harrison, C., & Harrison, W. P. (2012). Introduction to Health Care Finance and Accounting.

Cengage Limited. https://capella.vitalsource.com/books/9781285011950

Moody, C. (2021, March 18). How Does Medicare Reimburse Hospitals? Medicare & Medicare Advantage Info, Help and Enrollment. https://www.medicare.org/articles/how-does- medicare-reimburse-hospitals/