Examining Healthcare Reimbursement Systems
Order Description
The healthcare reimbursement systems in" rel="nofollow">in the United States are complex. A health in" rel="nofollow">information management professional needs an understandin" rel="nofollow">ing of the basic prin" rel="nofollow">inciples of the third-party payer system and the many options that are available to citizens through government-funded healthcare programs. Private and commercial in" rel="nofollow">insurance companies offer a different menu of options to their clients. All third-party payers are in" rel="nofollow">interested in" rel="nofollow">in decreasin" rel="nofollow">ing healthcare costs while improvin" rel="nofollow">ing quality and controllin" rel="nofollow">ing access to unneeded services.
Examin" rel="nofollow">ine the complexity of the healthcare reimbursement systems and begin" rel="nofollow">in to compare the similarities and differences between them. To complete this task, you will discuss each type of healthcare in" rel="nofollow">insurance plan listed, as well as the plan components, reimbursement provisions, restrictions, and the impact of government regulations.
A. Discuss the components of each of the followin" rel="nofollow">ing in" rel="nofollow">insurance plans:
• Fee for service (in" rel="nofollow">indemnity) plans
• Managed care plans
• Government-sponsored health plans (i.e., Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), Military/TRICARE, Indian Health Service).
• High-deductible health plans/healthcare savin" rel="nofollow">ings accounts
B. Discuss the restrictions of each of the followin" rel="nofollow">ing in" rel="nofollow">insurance plans:
• Fee for service (in" rel="nofollow">indemnity) plans
• Managed care plans
• Government-sponsored health plans (i.e., Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), Military/TRICARE, Indian Health Service).
• High-deductible health plans/healthcare savin" rel="nofollow">ings accounts
C. Discuss the in" rel="nofollow">inpatient reimbursement process for each of the followin" rel="nofollow">ing in" rel="nofollow">insurance plans:
• Fee for service (in" rel="nofollow">indemnity) plans
• Managed care plans
• Government-sponsored health plans (i.e., Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), Military/TRICARE, Indian Health Service).
• High-deductible health plans/healthcare savin" rel="nofollow">ings accounts
D. Discuss the outpatient reimbursement process of each of the followin" rel="nofollow">ing in" rel="nofollow">insurance plans:
• Fee for service (in" rel="nofollow">indemnity) plans
• Managed care plans
• Government-sponsored health plans (i.e., Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), Military/TRICARE, Indian Health Service).
• High-deductible health plans/healthcare savin" rel="nofollow">ings accounts
E. Analyze the impact the Medicare and Medicaid Patient and Program Protection Act of 1987 had on Medicare and Medicaid.
F. Discuss how third-party payment calculations impact healthcare reimbursement in" rel="nofollow">in healthcare organizations.
G. Acknowledge sources, usin" rel="nofollow">ing APA-formatted in" rel="nofollow">in-text citations and references, for content that is quoted, paraphrased, or summarized.