Essay Sample on Key Elements Impacting the Medicare Legal and Financial Reimbursement Practices

Factors impacting Medicare legal and financial reimbursement practices today are inclusive of the nature of ailment being treated, the type of physicians performing clinical evaluations, medical necessities, and the length of time taken in treating a medical condition. Prospective Payment System (PPS) and Federally Qualified Health Center (FQHC) also impact the reimbursement practices remitted by the government via the Medicare program (Chang, Bynum & Lurie, 2019). Particularly, that is because PPS Medicare Payments are remitted based on a fixed amount depending on the classification of the healthcare services offered (Chang, Bynum & Lurie, 2019). Contrary, the FQHC reimbursements are offered to beneficiaries based on their abilities to pay or access various essential healthcare services.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Order now

Today, Medicare is updating its regulations and regulatory provisions by reforming existing Medicare legislation that are considered unnecessary, obsolete, or burdensome to medical care providers. Subsequently, such amendments promote the efficiency, transparency, as well as burden reduction in Medicare reimbursement practices, which is essential in ensuring that all persons are equitably offered financial support to access quality health covers. Also, coverage differs between the different programs in Medicare and it also impacts the level of reimbursement issued for essential healthcare services. For instance, Part A of Medicare reimburses for costs of the hospital as an outpatient while Part B of Medicare reimburses for laboratory tests, preventive services, and doctor visits.

Key Sources Identified

There are several sources that can be obtained from the CMS.Gov as well as Medicare.Gov online platforms that can be employed in defining the nature of reimbursement methods employed. Additionally, that is also in staying current and informed on previously identified legal and financial elements that impact reimbursements. Such sources contained a range of current information that is regularly updated to inform on any changes in reimbursement practices in the healthcare sector. Below is the list of the relevant websites that can be utilized for resource information on Medicare reimbursements in the healthcare sector.

1. CMS.Gov Sources https://www.cms.gov/Medicare/Medicare

https://www.cms.gov/cciio/index

2. Medicare.Gov https://www.medicare.gov/

Medicaid and CHIP Reimbursement Resources

Description of Key Elements Impacting Medicaid and CHIP Legal and Financial Reimbursement Practices

To stay updated on the status of a claim, an individual can seek assistance from an insurance agent with resources to identify the procedures of a reimbursement application. Also, reimbursement procedures as well as practices might vary from one state to another depending on the individual State laws and legislations governing reimbursements in the healthcare sector. Such variations in the reimbursement practices may affect or alter the amount of reimbursement issued to healthcare practitioners between physicians in different states, after treating similar medical conditions. An individual can stay informed about the recent changes in financial and legal reimbursement practices by checking the Medicare and CHIP official websites occasionally for any updates.

Key Sources Identified

The Medicare resource can be utilized to provide essential information of any updates in policy legislation in Medicare that might impact the amount reimbursed for various healthcare services. Additionally, the resource can also provide information on the State level changes in Medicare reimbursements, which is essential in enabling individuals to stay updated with the recent or most updated information pertaining to the cover compensation for various healthcare services rendered.

Real-Life Example of How Healthcare Professionals Can Use Medicaid and CHIP Resources In their Role

An ideal example of how a medical practitioner can use the identified resources in the healthcare sector in the provisioning of essential medical care services in on identifying the cost of dental treatment reimbursement. In this case, a medical practitioner can find out the updated information on the rates of reimbursement that he/she can be offered after offering different types of dental care services in a clinical setting. Additionally, it is essential for a healthcare organization to stay updated on legal and financial policies that might impact the cost of essential medical care services issued to patients. Moreover, through such information, it is possible for a hospital to determine whether it can be in a position to offer medical care services to different types of patients and not incur losses due to under-reimbursement.

Private Insurance Reimbursement Practices

Description of the Key Elements Impacting Insurance Legal and Financial Reimbursement Practices

In today’s healthcare sector, the key elements impacting the private insurance legal and financial reimbursements practices today are the changes in policies impacting healthcare coverage in the nation. For instance, the Patient Protection Affordable Care Act (PPACA) legislation changes impacted the amount of reimbursement remitted to physicians for offering medical services to the public (Rosenbaum, 2011). Particularly, that is because the PPACA was developed to promote the fair and subsidized cost of coverage to the public (Rosenbaum, 2011). Subsequently, the creation of the policy impacted the level of premiums requested by private medical insurance corporations from clients, and also the amount of reimbursement they issued to physicians for patients’ treatment coverage.

Today, reinsurance plans might differ between employers. Additionally, this can occur due to the variations of the job descriptions given to different workers functioning in varying organizations. In this case, different insurers' coverage may differ depending on their workers’ salary bracket and job classification – short term and permanent. Private insurance policies might also be impacted by the occurrence of factors like the Employer-Based Self-Pay policy. In this case, the Employer-Based Self-Pay permits employers to make savings on the profit margin, which an insurance corporation sums up on the premiums remitted to attain a full cover plan. Contrary, for employees covered under the Consolidated Omnibus Budget Reconciliation Act (COBRA), private insurers are required to continue offering medical cover to employees and their families even after such individuals have lost their jobs.

Key Sources Identified

The Center for Consumer Information & Insurance Oversight can be employed to provide information to insurance companies and medical practitioners on factors impacting reimbursement practices. Additionally, the resource database provides data on various legislations that might impact the employment sector and influence a variation in the amounts reimbursed to patients employed in different workplace environments. Collectively, the information presented in the stated website can be employed in providing a comprehensive data on coverage options for the public in order to make an informed choice on the best healthcare insurance coverage that they should adopt.

Real-Life Example of How Healthcare Professionals Can Use the Resource

An example of how a medical practitioner can use the information presented in the resource is in determining the classification of coverage that a patient attaining essential treatment services can qualify. Also, it would be essential for a healthcare organization to keep updated on the financial and legal issues that might impact the level of their reimbursements attained by using the stated resource. Additionally, that is because by keeping updated on financial and legal aspects of insurance cover programs, a medical organization can be in a position to maximize the reimbursement that they attain after offering essential medical care services to their patients.

References

Chang, C. H., P W Bynum, J., & Lurie, J. D. (2019). Geographic Expansion of Federally Qualified Health Centers 2007-2014. The Journal of rural health: official journal of the American Rural Health Association and the National Rural Health Care Association, 35(3), 385–394. https://doi.org/10.1111/jrh.12330

Rosenbaum S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public health reports (Washington, D.C.: 1974), 126(1), 130–135. https://doi.org/10.1177/003335491112600118