Reimbursement In Health Care
Finance plays a very huge role in the health care industry. Finance keeps things in order, so that the business will run smoothly. Finance must be able to provide accurate, relevant and timely information. In order for decision making to be effective, accurate interpretation of financial information is a must. There are many laws and regulations when it comes to health care. However, there are some issues when it comes to regulatory process. Regulations that implement the healthcare law effects the choices many people can make and is/can be very expensive (Ellig 2012).
Coding and reimbursement go hand in hand. Proper medical coding is important on many levels, from ensuring accurate payment for physicians to creating a valid record of …show more content…
Third-party payers include private insurers, such as Blue Cross and Blue Shield, and public (government) insurers, such as Medicare and Medicaid. Third-party payers use several reimbursement methods to pay providers, depending on the specific payer and the type of service rendered (Gapenski 2013). There are two classifications for payment-fee-for-service and capitation. Fee-for-service means exactly what it says. So, the more services done, the more the reimbursement will be. Reimbursement is based on charge, cost and prospective payment. With charged-based reimbursement, the doctor is in control. The payer pays based on a rate schedule, which the doctor creates. Cost based reimbursement guarantees the doctor will be paid if the service is delivered. Prospective payment reimbursements are determined before the service is done. The charge can be per procedure, diagnosis, per day, bundled payment, etc. Capitation is a bit different. The doctor is paid a fixed amount (monthly), regardless of the services completed. Coding on reimbursement does not only affect the doctor’s pay. An inaccurate code could result in the doctor being underpaid by thousands of dollars. It also affects the patient’s quality of care. It is very important that doctor document every detail regarding the
Coding and reimbursement go hand in hand. Proper medical coding is important on many levels, from ensuring accurate payment for physicians to creating a valid record of …show more content…
Third-party payers include private insurers, such as Blue Cross and Blue Shield, and public (government) insurers, such as Medicare and Medicaid. Third-party payers use several reimbursement methods to pay providers, depending on the specific payer and the type of service rendered (Gapenski 2013). There are two classifications for payment-fee-for-service and capitation. Fee-for-service means exactly what it says. So, the more services done, the more the reimbursement will be. Reimbursement is based on charge, cost and prospective payment. With charged-based reimbursement, the doctor is in control. The payer pays based on a rate schedule, which the doctor creates. Cost based reimbursement guarantees the doctor will be paid if the service is delivered. Prospective payment reimbursements are determined before the service is done. The charge can be per procedure, diagnosis, per day, bundled payment, etc. Capitation is a bit different. The doctor is paid a fixed amount (monthly), regardless of the services completed. Coding on reimbursement does not only affect the doctor’s pay. An inaccurate code could result in the doctor being underpaid by thousands of dollars. It also affects the patient’s quality of care. It is very important that doctor document every detail regarding the