employee benefits instead of buying plans from other companies. They create self-funded plans so they do not have to pay premiums to an insurance company or a managed care organization. These plans will give the responsibility of paying for medical services directly. The employer must choose the benefit levels and the types of plans they wish to offer. They are able to set up their own provider networks or lease an organizations network. They can also offer vision and other types of insurance too. The
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The original Medicare plan does not cover some physician and hospital services. The Medigap program is a supplemental insurance policy that assists beneficiaries in paying for non-covered physician and hospital expenses. The policy is sold by private insurers to help with these services that Medicare does not cover. An individual must be a member of Medicare plans A or B to meet the eligibility requirement for Medigap. The core benefits for the Medigap program are Part A daily coinsurance for days
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Checkpoint: Inpatient and Outpatient Hospital Services HCR 230 Checkpoint: Inpatient and Outpatient Hospital Services The inpatient and outpatient hospital services are two totally different processes that are used in the medical facilities or practices at different timing. The major differences between inpatient and outpatient hospital services are the type of services they provide‚ the coding‚ and billing process. With the inpatient care patients are required to be admitted in a hospital
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Fee-for-service payment method is based on provider charges which also mean the fee is paid after the patient receives services from the doctor. Fee-for-service would consist of the patient paying his or her monthly payment on time and then when visiting the doctor unless there is a co pay or a procedure that is done that day then there is no payment needed. If by chance there is a procedure done that day then before leaving there might be a cost when the medical biller bills the company the health
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HCR 230 Wellness Medical Practice Part A Wellness Medical Practice welcomes you as a patient. The practice strives to provide its patients with excellent healthcare. In order to keep the cost of our medical services comparable with other medical providers in the area‚ Wellness Medical asks patients to become familiar with the practice’s Financial Policy. PAYMENT: Each office visit payment is rendered at that time‚ unless prior payment has not been arranged with billing staff. Payments
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Comparing Cost Control Strategies HCR 230 Employer sponsored medical insurance provides employees coverage under group health plans. Group health plans are managed by the Human Resources department. Employers are able to create a benefits package that can be cost effective and offers reduced costs to employees. There are some benefits that can be omitted an example could be a prescription plan. A specific set of network providers can be established for certain coverage such as mental
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health maintenance organizations (HMO)‚ point of service (POS). Indemnity plans cost the most for employees and they usually have to choose a PPO plan. The new consumer driven health plan (CDHP) which a lot of people are picking‚ it has a high deductible combined with a funding option of some type. All of the plans have unique features for coverage of services and financial responsibility. PPO plans are the most popular plan that doctors‚ clinics‚ hospitals‚ and pharmacies contract with. One of the reasons
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number‚ or the plan of service code is wrong. This has to be fixed before anything further can happen. Automated review is a system that checks for ten things that maybe reflected on their payment policy. The review checks for the following; patient’s time limits for filing claims‚ referral forms‚ preauthorization‚ and the patient’s eligibility benefits‚ bundled codes‚ non-covered services‚ medical review‚ concurrent care‚ utilization review‚ and duplicate dates of service. The third step is manual
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an ambulatory care facility and an inpatient hospital. Ambulatory care facilities consist of physician offices‚ walk in clinics‚ health departments‚ urgent care centers or a facility that provides medical treatment to patients who do not require an overnight stay (Gartee‚ 2011). Whereas an inpatient facility treats patients who require services longer than 24 hours but generally do not exceed 30 days and these facilities often are hospitals that provide inpatient stays. However‚ as the cost of healthcare
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Service Blueprint Service blueprinting is defined as a tool for simultaneously depicting the service process‚ the points of customer contact‚ and the evidence of the service from the customer’s point of view. The proposed blueprint allows for a quantitative description of critical service elements‚ such as time‚ logical sequences of actions and processes‚ also specifying both actions/events that happen in the time and place of the interaction (front office) and actions/events that are out of the
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