Reimbursement In Health Care

It is no secret that the cost of American healthcare is becoming increasingly more expensive. However, the issue of the rising cost of healthcare and its severity needs to be recognized as a major problem. Health prices are steadily increasing in the United States, and there is no sign of it stopping. Since 1970, spending on American health care has grown 9.8%, which is a rate that is growing faster than the economy (“New Technology”.) Furthermore, health insurance premiums are also increasing at a rate five times faster than American salaries, which makes it difficult for families to afford health care coverage (Zuckerman 28). Therefore, it has become an obligation to address why the cost of American health care is soaring and to seek out a solution to lower the cost. Many would jump to the conclusion that the United States simply charges too much for their medical services, but there are deeper influences that need to be analyzed. The causes of the rising cost of health care are people not using preventive health care, the development of modern technology, and the treatments being overprescribed. A possible solution is to have preventive health care services available in clinics of low-income areas.

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

Health care is meant to provide medical or psychological care for the entire human population. In order to pay for health care, one must have health insurance or be able to pay out of pocket. However, health care in the United States are nowhere near cheap. In fact, America has the worst healthcare system in the world. America’s health care system is a direct-fee system. A majority of countries around the globe are government controlled. Taxes primarily finance their health care access and delivery. Unfortunately, for America, the US government does not pay for most of its citizens’ health care (Health Care Issues, 2015). America’s health care system is in jeopardy due to increasingly high prices and lack of access.

The single most important impetus for healthcare reform throughout recent history has been rising costs (Sultz, 2006). In the book called The healing of America: a global quest for better, cheaper, and fairer health care, Reid wrote that the nation’s health care system has become excessively expensive, ineffective, and unjust. Among the world’s developed nations, the US ranks near the bottom for healthcare access and quality. However, the US ranks at the top for health expenditure as a percentage of the Gross Domestic Product (GDP) and average of $7,400 per person (Reid, 2010). Therefore, Americans are spending

The rising healthcare cost is an issue that affects many working class Americans. Experts have tried to come up with different ways to make health care more affordable and easily accessible to all. Despite all the efforts and even after the Affordable Care Act, there are still millions of Americans without health insurance coverage and therefore unable to access the necessary medical care. According to a 2015 report by the U.S Census Bureau, there are over 33 million uninsured Americans. (“Health Insurance Coverage in the United States: 2014 - p60-253.pdf,” n.d.) The Affordable Care Act has unquestionably made healthcare more accessible and reduced the number of uninsured Americans. However, there are still millions of

Substantial increases in health care costs has put significant strains on federal, state, and household budgets as well. Quality of health care varies widely, even after controlling for cost, patient preferences, and sources of payment (ATR, 2015). Many Americans lack health insurance coverage which also put a burden on the health care system itself, onto the consumers, and the tax payers as well.

Healthcare reimbursement systems within the United States are a complex structure for obtaining payment for services rendered. The healthcare system officers are required to understand the ordinary principles of the payer system. Understanding the rules, and keeping up with the continuous changes will allow the providers, physicians, and facilities to gain an advantage in this growing healthcare domain. Both private and commercial insurance companies provide a diverse menu of choices to customers. All third-party payers create interest in decreasing healthcare costs and improve control access to the not needed services. This paper will address the complexity of the healthcare reimbursement systems in the United States. Additionally, the research

A current problem in the advanced practice roles is reimbursement for Medicare, which “is set at 85% of the physician rate, a payment disparity that the APRN community has quietly accepted” (Mason, Leavitt & Chaffee, 2014, p. 396). An example of this is evident through ear infection visits in the office. When a patient comes in for otitis media their reimbursement is “15% less than when the same condition is treated by a physician” (Mason, Leavitt & Chaffee, 2014, p. 396). MedPAC an independent advisory commission called The Medicare Advisory Payment Commission has suggested that there should be no payment differentials between providers (Mason, Leavitt & Chaffee, 2014). However, still advanced practicing nurses still do not receive the same amount of reimbursement for the same services rendered.

The Centers for Medicare and Medicaid Services is a government agency within the U.S. Department of Health and Human Services. The CMS is in control of certain health care programs. Reimbursement is used in the healthcare field by coding specialist in hospitals and physicians’ offices. These specialists assign appropriate diagnosis and procedure codes based on the patients’ individual medical record. Once the information from the patients’ record is coded, a bill or claim is composed and sent to a third-party payer for the reimbursement of the services that were performed on the patient. Depending on the payer, they may request that a copy of the patients’ medical record be sent with the claim.

With the rising number of uninsured Americans, health care has been a major issue in the United States. Due to “The Great Recession” and the growing number of Americans who found themselves unemployed, the number of uninsured Americans has rose from 46.6 million in 2005 to a record number of 50.7 million in 2010. Many of these uninsured again have lost their employee health insurance benefits or they made the decision to cut their health insurance just to cut back costs. The rising prices of health care have also been a concern over the last few years. With new medical technology and increasing prices of prescription drugs, it has become hard for one particular group to keep up. Our

The government influences the delivery of healthcare by setting forth several different requirements. As with any state or federal agency, licensure of both the facility and providers are required (Gartee, 2011). In addition, there are certain standards that must be met by the facility in order to participate in government funded programs. The most widely known programs within the healthcare industry are Medicare and Medicaid.

It is no secret that the cost of American healthcare is on the rise. Already the nation is spending about $1.65 trillion a year on healthcare. That represents 15 percent of gross domestic product, the total output of goods and services. It consumes one-fourth of the federal budget, more than defense. (Allan Rubin) This is due to the factors of expensive technology, less stringent HMO cost management, and more specifically to this paper, rapidly rising drug costs. Surveying nearly 3,000 employers, Mercer Human Resource Consulting finds that their health-benefit costs rose 10.1 percent this year, while inflation hovered around 2 percent.

The United Stated has the costliest medicinal services among other created nations. As indicated by information aggregated by the Peter G. Peterson Foundation, the U.S. spends more on human services, an expected $9,000 per individual in 2016. (Per) The usage of the Affordable Care Act saw a decline of uninsured from 16.6% out of 2013 to 10.4% by 2016 yet 28.2 million non-elderly grown-ups in 2016 were still without medical coverage scope (Key) Even with the high dollars spent and medical coverage commercial centers settled, a great many Americans still don't have medical coverage scope.

US health care expenditures have been rising quickly over the past few years; it has risen more than the national financial system. Nonetheless a number of citizens in the US still lack appropriate health care. If the truth be told, health care expenditures are going to continue to increase; in addition numerous individuals will possibly have to make difficult choices pertaining to their health care. Our health system has grave problems that require reform, through reforming, there is optimism that there will be an increase in affordable health care and high-quality of care for America. Medicaid, Medicare and private sector insurances are all going through trials and tribulations because of

The healthcare system plays a key role in the economic stability of our country, as every year trillions are spent in attempt to combat disease and health issues that plaque humanity. As it makes up a significant amount of the expenditures in the economy, so the costs associated with health care of those in pain from illness and injury, including lost productivity, increased need of assistance in living and also the cost of death in some cases, is important to the economic stability and over all standard of living in our country. The key to economic prosperity is balancing the need for care with the costs of illness to keep as many people healthy and well without breaking the bank of collective society. The costs of healthcare have been increasingly problematic in recent years with so many issues surrounding the current system. With the “total health care spending in the United States expected to reach $4.8 trillion in 2021, up from $2.6 trillion in 2010 and $75 billion in 1970, meaning that health care spending will account for nearly 20 percent of gross domestic product (GDP), or one-fifth of the U.S. economy, by 2021” (Aetna). With this in mind it is apparent that as we look at the trillion-dollar industry of the medical community it seems that it needs to be a major focus of our nation as a whole and with the many issues come many creative solutions. First let us analyze the reasons behind the current cost and the major problems facing this industry and than discus what