INFLUENCES ON PROVIDERS 6
Influences on Providers
Influences on Providers
When it comes to reimbursement there are multiple methods for healthcare organization to get their money. The cost of healthcare is going up and many people don’t have the means to pay for it. Employees in the healthcare industry are overworked and hospitals continue to be understaffed. While many people are left uninsured and in debt because of healthcare bills.
The two main types of reimbursement methods are retrospective and prospective reimbursement. Retrospective payment system means that the healthcare provider receives payment for services provided. Prospective payment system means that provides are given reimbursement at a predetermined level. There is also a fee-for-service reimbursement option where providers can be paid almost 100% of the price that they have requested.
People either have public health insurance, private insurance, or pay out of pocket. Public health insurance is funded by the government and it includes Medicaid and Medicare. People can buy private insurance directly from the insurance company or get insured through work. People who don’t have either are left uninsured and have to pay out of pocket which can get very expensive.
Public health insurance is a hot topic with many people. Some people feel like there are people who have public health insurance that should not have been approved. Others feel like everyone should have free public health insurance. Since public health insurance comes from the tax payers pockets it is an issue that is wildly discussed by every social group.
Buchbinder and Shanks (2017), “Over time, these public programs have been expanded to bring more eligible individuals into coverage, have added types of benefits, and have changed in a variety of other ways. One such major expansion took place with the creation of the Children’s Health Insurance Program in 1997, which provides health insurance coverage to children in low-income families. The most recent, and some would argue the second most historic, change in health insurance occurred in March 2010 with the enactment of the Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act, ACA or Obamacare. The primary intent of this health care reform legislation was to expand access to care by providing increased health insurance coverage and bringing the uninsured into coverage”.
Physicians, hospitals and primary care providers all have different reimbursement methods. According to Buchbinder and Shanks (2017), “A Resource-Based Relative Value System (RBRVS) was implemented in 1992 for reimbursement for physician office services rendered to Medicare beneficiaries. This system pays a prospective flat fee for physician visits and is based on the Healthcare Common Procedure Coding System (HCPCS) codes used by outpatient health care providers and medical suppliers to code their professio...