Essay On Medical Reimbursement

Without strategic planning, several things can go wrong including missing out on great opportunities. Strategic planning is an organization’s outline to help achieve its purpose. Although strategic planning begins at the top of the pyramid, it is more effective when it is carry out as a whole among other in the organization. Having a good internal control system in place protects an organization from high risk, fraud, and more. Jackson Memorial Hospital has several weaknesses which are similar to its competitors and other health care organizations. For instance, Mount Sinai Medical Center one of Jackson Memorial’s competitors, encountered lack of strategic planning that led to many issues such as with readmissions, surgical complications,

Q2-Evaluate Vegemite’s brand image based on the social media research undertaken by Talbot and his team .In light of these historic factors, Why did Talbot want to revitalize the brand?

The Reimbursement Officer I position performs moderately complex Medicare Part D claims processing and reimbursement work for the San Antonio State School. Performs complex technical accounting work in the Reimbursement Department. Duties may include performing detailed assignments in recording, classifying, examining and verifying financial records, documents, or reports for individuals that receive Medicare Part D revenue living at the San Antonio State School. Work involves determining eligibility; obtaining financial information, maintaining accounts, and collecting charges for support, maintenance and treatment provided to the individuals at the San Antonio State School. Works under the Reimbursement Manager’s supervision with moderate latitude for the use of initiative and independent judgement.

Each state has their own policies for Medicaid eligibility, services and payments. Medicaid plans have three eligibility groups such as categorically needy, medically needy and special groups. Children's Health Insurance Program (CHIP) is a program that offers health insurance coverage for uninsured children under Medicaid. If Medicaid does not cover a service, the patient may be billed if the following conditions have been met such as the physician informed the patient before the service was performed that the procedure was not covered by Medicaid and if the patient has signed an Advance beneficiary Notice form. However, there are also conditions where the patient cannot be billed if necessary preauthorization was not obtained or service

The South Carolina Title XIX State Plan, also known as Medicaid, was designed to maintain the provision of “quality health care to low income, disabled, and elderly individuals” (South Carolina Department of Health and Human Services, 2016). The South Carolina Department of Health and Human Services (SCDHHS) acts as the designee for this administration, managing the state and federal reimbursement of funds for approved medical providers. Services are designed to provide services for diagnosis, treatment, and management of illnesses. The Management Care Organization program provides insurance coverage through a network comprised of contracted, providers who are paid a “per member per month capitated rate” (SCDHHS, 2016). These

Medicaid has grown exponentially after healthcare was expanded under the Affordable Care Act. However, this did not guarantee an increase in access to health care services, as many providers do not accept Medicaid beneficiaries, one of many reasons being low reimbursement rates. This discrepancy in rate reimbursement is further underscored when compared to those

Medicare and Medicaid are programs that have been developed to assist Americans in attainment of quality health care. Both programs were established in 1965 and are federally supported to provide health care coverage to vulnerable populations such as the elderly, the disabled, and people with low incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is Medicare? What is Medicaid?” 2008).

Some families meet the financial qualifications to receive government assistance, but the West Virginia Medicaid program only covers vision care for most adults every three years. Preventive exams are not paid for annually. West Virginia is one of eighteen states that Medicaid will only coverage emergency services for dental care. Preventative care is not covered with Medicaid insurance. (Haney, 2016, July 25, 2017, February 13) The Medicaid expansion program has increased the number of West Virginians on Medicaid. Almost half of the West Virginian population is considered to live in a rural Appalachian area and are more likely to be dependent on Medicaid insurance. West Virginia is the state with the highest percentage of its

The U.S. health care system is a scrutinized issue that affects everyone: young, old, rich, and poor. The health care system is comprised of three major components. Since 1973, most Americans have turned to managed-care programs, known as HMOs. The second type of health care offered to Americans is Medicare, health care for the elderly. The third type of health care is Medicaid, a health care program for the poor.

Medicaid and Medicare are two different government programs. Both programs were created in 1965 to help older and low-income families be able to buy their own private health insurance. These programs were part of President Lyndon Johnson’s “Great Society” plan, a commitment to helping meet the needs of individual health care. They are social insurance programs, which allow the financial load of patient’s illnesses to be shared by other healthy, sick, wealthy, and lower income individuals and families.

Direct and limited reimbursement plans are methods used to compensate employees for business expenses. According to Johnston and Marshall (2009), each type of reimbursement plan offers positive and negative effects depending on the organizational environment. For example, direct reimbursement covers all expenses that are approved by the sales manager; conversely, limited reimbursement plans have a preset limit of allowable expenses. The direct reimbursement provides a way to motivate sales representatives to partake certain activities that are reimbursable and discourage unwanted behavior because it is not reimbursable. The limited reimbursement plan requires budgeting and a good understanding of the expenses a particular sales representative will incur.

Teaser: Being insured, doesn’t necessarily guarantee you’ll have enough money to pay the doctor, hospital, pharmaceutical and other medical bills.

Government financed health care typically has more control to place limitations on care offered to patients and doctors in order to keep costs down. Since payers must try to deliver the most care for the

Medicare and Medicaid are two of the United States largest broken systems, which must sustain themselves in order to provide care to their beneficiaries. Both Medicare and Medicaid are funding by a joint effort between the federal government and the local state government. If and when these governments choose to cut funding or reduce spending, Medicare and Medicaid take the biggest hit. Most people see these two benefits as one in the same, two benefits the government takes out of their pay check to help fund health care. While the government does deduct a sum from paychecks everywhere, Medicare and Medicaid are very two very different programs.

Strategic Planning: Due to the current issues, both internally and externally, the organization is facing, Dr. Townsend is challenged to prepare an action plan to implement the proposed strategy needed to restore the organization back to financial health and improve the morale among the physicians and support staff. Another course of planning Dr. Townsend will challenge is the organizations old structure into a way that all patients will be satisfied.