Ever evolving technology, scientific breakthroughs, extended life expectancy, and unemployment often involves leads to a high level of uncollectible accounts within the healthcare industry When a patient receive services provided by a healthcare facility or physician’s office patient financial services gather patient demographics, insurance information, and income information. The information provided by the patient is reviewed to determine their financial status thereby determining their ability to pay for healthcare services. When the patient is deemed, they cannot afford to pay for medical services they determine if the services would be categorized as free services, or a sliding scale/discounted services. If services are provided free of charge or on a discounted rate, then the services are exempt from tax and is categorized as a charitable item thereby the service is recordable under uncollectible items as charity services versus an uncollectible debt.
Patient financial personnel must consider various
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Patient financial services in managed care environments are now challenged with gauging the patient’s ability to pay with the increase of liability on high-deductible health plans. “The inability of many consumers to pay high deductibles is projected to produce outcomes that damage bottom lines of healthcare businesses” (Boland, PhD; Gibson, PhD; 2014).
Although gross uncollectible accounts are a combination of charity care and uncollectible debt, implications generally occur when recording on a healthcare institutions bottom line, further, charity care and bad debt uncollectible must be recorded and documented independently. Implications stem from recording and classification of uncompensated care. Improper classification of charity care is often mistaken for as bad debt in turn leads to bad debt amounts being over the profit amount when recorded on financial
The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.
Kutscher, B. (2015, June 24). High-deductible plans change how hospitals interact with patients. Modern Medicine, para 1.
Medical Debt Collection starts when medical services are rendered, whether it’s by choice or an emergency. A serious illness or even a relatively brief stay in a hospital is apt to leave you with a pile of medical bills that you cannot afford to pay, even if you have health insurance(Reed and Detweiler,2015). After
H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/
Accelerating cash collections at the point of service has never been more critical than it is today. Sophisticated accounting tools that enable providers to analyze patient utilization and outcomes help practice managers monitor payer performance and evaluate external contracts effectively. Growing financial pressure to strive toward more efficient claims flow through the revenue cycle means every provider must search for innovative tools to overcome the challenges.
Melnick, G., & Fonkycj, K. (2013). Fair pricing law prompts most California hospitals to adopt policies to protect uninsured patients from high charges. Health Affairs, 32(6), 1101-1108. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/1372932073?accountid=2532
Another term often used with both not-for-profit and for-profit hospitals is uncompensated hospital care. With not-for-profit and for-profit, revenues come from daily operations. What happens if a person cannot afford the care in a not-for-profit hospital? Regardless of the type operation, hospitals must stabilize the patient and transport to a public hospital, even though they are not required to treat these patients. This uncompensated care is classified as uncompensated care, bad debt, or charity care. For-profit hospitals write off this bad debt and use these figures to offset their profits and to assist in developing their costs to Medicare and Medicaid programs.
Another downside to High Deductible Health Plan (HDHP) is the apprehensiveness to use the insurance, even the benefits that are free or at a low cost. “Enrollees in high-deductible health plans are likely to reduce the preventive care use and are largely; because they are unaware of the fact that preventive care benefits are free or at a low cost (Dolan February 2016).” Recent analysis showed that low-income workers were more likely than higher earners to avoid certain kinds of care when they were enrolled in high-deductible plans coupled with savings accounts. The analysis from the Employee Benefit Research Institute, found that low-income people even skipped free preventive services like flu shots and cut back on doctors’ visits. Primary and preventive
In this country there are numerous concerns about health care economics. Several factors contribute to the increase of health care costs. One area of concern is the impact of managed care on health care finances. Managed care has been around since the early 1970s. The definition of managed care is a set of contractual and management methods implemented to manage the financing and delivery of health care services. Initial implementation of managed care was for health care cost saving (Getzen & Moore, 2007, p. 203, para. 1). Though Managed care initially addressed several health care finance issues, there are still problems with the current
Obtaining reimbursement for services provided is a necessity for the survival of many health care organizations. This paper will explain, in my opinion, why the Centers for Medicare and Medicaid Services (CMS) are involved in this development and how it affects the American public. I will offer a suggestion to ensure meeting policy and procedure. I will finish by discussing three ideas listed on the CMS website.
Many people are concerned about rising health care costs. In reaction to this, some individuals and companies are gravitating toward the assumed lower prices of Health Maintenance Organization (HMO) health plans. HMOs spend billions of dollars each year advertising their low cost services. While these savings look good on paper, there are many pages of small print. The explanation after the asterisk indicates that not only do the HMOs lack lower costs, but they also short-change the patient in quality care. Much of the money spent on premiums goes directly into the pockets of stockholders and less is then available for
In an attempt to understand the impact of managed care in the U.S, I look at the most commonly expressed complaints against the organization. In a survey of consumers, 60% said that managed care had not made a difference in health care cost or had actually been the cause of the increase of health care cost. Managed care has had an impact on slowing the rates of growth in the costs of two major health care producers: hospitals and physicians. Little evidence has suggested that the current reimbursement are inadequate to the care provided. The quality of care is a highly debated issue. Physicians are concerned that the quality of care in managed care organizations may reflect the loss of professional autonomy through pre-authorization procedures.
One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare
Managed care was established in order to manage health care cost, utilization, and quality (Kongstvedt, 2015). In managed care, health insurance is provided through HMO, PPO, and other types of managed care. It has the potential to reduced health care spending and improved the quality of care. However, despite of its success in improving the quality of care through preventive health care services, chronic disease management program, and so forth, many physicians are reluctant to be part of the managed care environment. Some of the reasons are the impact of managed care to physician’s income and autonomy. Under managed care, insurers have decreased the fees paid to physicians. There are different ways how managed care organizations control costs. One of this is through selective contracting with health care providers and hospitals to lower costs. In selective contracting, health care providers agreed to accept lower prices in exchanged for guaranteed volume of patients under managed care plan (Culyer, 2014). This paper will discuss more issues and trends in Managed Care Organizations such as the rise of Medicaid Managed Care spending, the new Medicaid Managed care Rule, and the collaboration of Managed Care Organizations and Accountable Care Organizations to reduce health care spending and improve efficiency of care.
Gapenski, L. (2006). Healthcare Finance (4th Ed.). Retrieved from The University of Phoenix eBook Collection database.