Healthcare Financial Environment. Introduction
|
|
- Megan Harper
- 6 years ago
- Views:
Transcription
1 Healthcare Financial Environment Introduction The United States (U.S) healthcare industry forms a very big part of the country s economy. It represents about 17% of the total personal expenditures per year. The provision of healthcare in the U.S is done by various entities including the state and local governments, non-profit organizations as well as for-profit organizations. The bigger ownership of these health facilities lies in the hands of private owners. Funding in the health care system is done via various schemes almost wholly based on different types of insurance covers offered by different providers of health care financial services. Medical care funding may be divided into three main sectors including the public sector (mainly by the government) and the private sector (by private insurance covers funded by employers and individuals) as well as the self payers that may be covered by no particular insurance scheme. All these organizations form an intertwined maze of connections between the healthcare service providers and the supportive financial organizations that fund this service provision through reimbursement schemes. The existence of various payment systems offered by third party payers such as government schemes and health insurance firms as well as self-payers makes a complex maze that raises issues of cost, inequality and quality service delivery. The different payment modes complicate the payment procedures especially; in cases of negotiated charge rates that differ under various schemes of cover. This has even led to some patients under schemes such as Medicaid and Medicare to be rejected by some service providers due non-conformity in reimbursement negotiations. 1 / 5
2 Additionally, most healthcare facilities find it difficult to handle their financial management because of the existence of numerous payment modes that all differ even with similar services. These challenges have led to various reform calls from various sectors within the industry, the public and the political wings. A large number of U.S citizens get their insurance health cover through schemes designated by their employers. Private employers may negotiate with private insurers to have their patients covered under their schemes. On the other hand, the public sector s employees may get cover under insurance schemes set up by the federal programs such as the Blue cross Blue shield federal employee program. Under these employee supported programs of health cover, the covered employees also contribute a percentage of the premium which differs depending on whether the cover is a single or family cover (Cameron & Cleverley, 2007). Employees also face additional charges that they have to pay in addition to the premiums paid. These additional payments within this financial structure come in form of co-payments and deductibles. These schemes form a sort of cost-sharing program. The cost spreading covers most of the expenses in medical care, but at times the insured may be required to pay part of the total cost as an up-front payment (deductibles) or a portion of the total cost (co-payment) (Gapenski, 2008). According to statistics 35% of medical expenses are covered by private insurance in the U.S. These insurance schemes are managed under policies aimed at negotiating a favorable fee at an exchange for quality medical care from selected networks of service providers. These service providers are reimbursed by the insurance firms upon the filing of service charges. The financial structure of most of these schemes is built on member contributions from employees and their employers. As stated earlier this contributions do not meet the entire costs and these may have to be supplemented by the co-payments and deductibles paid directly from enrollees of these schemes. Non-private government programs cover medical care provision to about 28% of the 2 / 5
3 total populace including the veterans, elderly, children, disabled and the poor (low income earners). The federal government also guarantees access to emergency medical care without considerations on whether the patient can be able to pay or not. This is provided under the EMTLA (Emergency Medical Treatment and Active Labor Act). However, there is no clearly laid out structure on how reimbursements can be made under the EMTLA; and as a result most payments have never been fully settled by the State. The U.S public spending on health is approximately 45%-56.1%, thus making the nation one of the biggest spenders on healthcare within the U.N nations (Cameron & Cleverley, 2007). There are various government funded programs meant to help in health care provision to various sections of the population, which are not necessarily government employees. These federal programs include Medicaid (a program administered via state authorities which covers low income earners under specific groups such as expectant women, the disabled and the children), Medicare (a program that covers the elderly citizens who are beyond 65 years of age), Veterans Administration (covers veterans), government run community clinics, county and state hospitals, National institute of health (it offers free treatments to patients participating in research programs and State Children Insurance Program (it covers children from low income families who are not covered under Medicaid) (Gapenski, 2008). Most of these programs are based on a policy framework that is driven towards the objective of creating equality in healthcare provision, by ensuring that even those that cannot access healthcare services are able to get medical care. Thus, most of the public healthcare programs are based on policies of fostering equal opportunity in healthcare for all citizens, by helping those that cannot afford healthcare in one way or another. The financial structures of these programs are either directly state funded or locally funded within the states, but the financial funds are obtained from taxes levied on the citizens. The last group of payment arrangement under self-payers mostly involves people unable to completely secure cover or sufficient cover, to the extent that they have to pay their medical 3 / 5
4 bills in the entirety or partially because of services that may not be under their cover. Most of the population in this category may go without medical attention totally because they are unable to obtain it through any of the available schemes. These presented modes of provision of financial funding presents a complex maze that gets even more complex in the processing of payments from various quarters that are supposed to fund medical care for different parts of the same population. The payments made for services are not standardized, because they are based on a multitude of negotiations from various third party payers (Ward & Finkler, 2006). The processing of reimbursements is also often covered with cases of fraud which lead to lack of payments if the patients cannot be traced to help process the reimbursement. The differences in amounts paid by different third party payers and self payers including those treated under charity care presents an accounting challenge. The consolidation of accounts becomes complex for accountants under healthcare management, thus presenting a unique challenge of managing healthcare in an efficient way(ward & Finkler, 2006). This multitude of slight variations and complexities makes healthcare financial management a little complex compared to other industries financial sectors (Ward & Finkler, 2006). Conclusively, the healthcare industry in America presents a complex challenge not only in healthcare financial sector, but also in the provision of the medical care itself. There is a visible need of standardization of payments as well as enhancement of affordability through the standardization. The lack of clear regulatory framework on health care finance has led to greater challenges in management which has in turn led to escalation of costs as third party payers and medical care provision networks work towards their own interests without regard for the patient. According to Fuchs and Emanuel (2005), the debate that should provide solutions at the moment should be geared towards standardization which should ensure accessibility, affordability and access to all citizens. References 4 / 5
5 Cameron, E. A. and Cleverley, O. W. (2007).Essentials of health care finance, sixth edition. Jones & Bartlett Learning. Fuchs, V., and Emanuel, E. (2005). Health care reform: Why? What? When? The Journal of Health Affairs, volume 24, issue number 6, p Gapenski, L. C. (2008). Healthcare Finance, fourth edition. Health Administration Press and Association of University Programs in Health Administration. Ward, M. D. and Finkler, A. S. (2006).Accounting fundamentals for health care management, Jones & Bartlett Learning. 5 / 5
Chapter 1: A Distinctive System of Health Care Delivery
Multiple Choice Questions Delivering Health Care in America, Sixth Edition Chapter 1: A Distinctive System of Health Care Delivery 1. The primary objectives of a healthcare system include all of the following
More informationUS Health Care System: Chronic Problems and Immigrants
US Health Care System: Chronic Problems and Immigrants Nuri Korkmaz, PhD Independent Researcher Bursa 16260 Turkey Abstract Access to the US health care system is becoming a discussion topic each time
More informationUniversal Healthcare. Universal Healthcare. Universal Healthcare. Universal Healthcare
Universal Healthcare Universal Healthcare In 2004, health care spending in the United States reached $1.9 trillion, and is projected to reach $2.9 trillion in 2009 The annual premium that a health insurer
More informationHealth Insurance (Chapters 15 and 16) Part-2
(Chapters 15 and 16) Part-2 Public Spending on Health Care Public share of total health spending over time in the U.S. The Health Care System in the U.S. Two major items in public spending on health care:
More informationMgmt 444. A Century of Healthcare Policy. Given the timeliness, it behooves us to explore the economics of healthcare policy
Mgmt 444 A Century of Healthcare Policy Given the timeliness, it behooves us to explore the economics of healthcare policy We will defer most of this discussion until the last week of class, by which time
More informationTRICARE Reimbursement Manual M, February 1, 2008 Double Coverage. Chapter 4 Section 4
Double Coverage Chapter 4 Section 4 Issue Date: Authority: 32 CFR 199.8 1.0 TRICARE AND MEDICARE 1.1 Medicare Always Primary To TRICARE In any double coverage situation involving Medicare and TRICARE,
More informationKENTUCKY HEALTH: GOVERNOR BEVIN S 1115 MEDICAID WAIVER
KENTUCKY HEALTH: GOVERNOR BEVIN S 1115 MEDICAID WAIVER WHAT IS IT? Kentucky HEALTH is Governor Bevin s signature Medicaid program that stands for Helping to Engage and Achieve Long Term Health. Also called
More informationTHE HOUSE FY 2014 BUDGET
THE HOUSE BUDGET BUDGET BRIEF MAY 2013 On April 10, the House Ways and Means (HWM) Committee released its Fiscal Year (FY) 2014 budget plan, and on April 24, after three days of debate and amendment, the
More informationEconomics of Policy Issues EC3060 Autumn 2016
Economics of Policy Issues EC3060 Autumn 2016 US Health Care Case Study Michael King 1 Health Care in Ireland Two-tier System: Socialised medicine with private options Socialised Medicine The government
More informationHR 676: 35 Questions and Answers
Prepared by Single Payer Now www.singlepayernow.net Updated Feb 9, 2009 HR 676: 35 Questions and Answers Q1: What is the name of this Act? {Section 1(a)} A1: This Act is called the United States National
More informationThe Congress, the President, and the Budget: The Politics of Taxing and Spending
Edwards, Wattenberg, and Lineberry Government in America: People, Politics, and Policy Thirteenth Edition Chapter 14 The Congress, the President, and the Budget: The Politics of Taxing and Spending Introduction
More informationHealth Care Reform. Navigating The Maze Of. What s Inside
Navigating The Maze Of Health Care Reform What s Inside Questions and Answers on Health Care Reform Health Care Reform Timeline Health Care Reform Glossary Questions and Answers on Health Care Reform I
More informationTRICARE Reimbursement Manual M, February 1, 2008 Double Coverage. Chapter 4 Section 4
Double Coverage Chapter 4 Section 4 Issue Date: Authority: 32 CFR 199.8 1.0 TRICARE AND MEDICARE 1.1 Medicare Always Primary To TRICARE With the exception of services provided by a Federal Government facility,
More informationCENTER FOR TAX AND BUDGET ACCOUNTABILITY
CENTER FOR TAX AND BUDGET ACCOUNTABILITY 70 E. Lake Street Suite 1700 Chicago, Illinois 60601 The State of Illinois Shortchanges Cook County on Federal Medicaid Payments Executive Summary Cook County,
More informationThe Costs of Doing Nothing: What s at Stake Without Health Care Reform
AARP Public Policy Institute The Costs of Doing Nothing: What s at Stake Without Health Care Reform November 2008 The Costs of Doing Nothing: What s at Stake Without Health Care Reform Table of Contents
More informationACCEPTING ASSIGNMENT 1a
ACCEPTING ASSIGNMENT 1a WHEN A PHYSIAN AGREES TO TREAT MEDICAID PATIENTS ALSO AGREES TO ACCEPT THE ESTABLISHED MEDICAID PAYMENT FOR COVERED SERVICES. 1b ADVANCE BENEFICIARY NOTICE - ABN 2a FORM GIVEN TO
More informationTarrant County Hospital District d/b/a JPS Health Network A Component Unit of Tarrant County, Texas
Auditor s Report and Financial Statements Years Ended Contents Independent Auditor s Report... 1 Management s Discussion and Analysis... 3 Financial Statements Balance Sheets... 9 Statements of Revenues,
More informationIllinois Medicaid Managed Care Organizations & Family Planning Services. IDPH Family Planning Workshop March 22, 2017
Illinois Medicaid Managed Care Organizations & Family Planning Services IDPH Family Planning Workshop March 22, 2017 Current structure of Medicaid managed care programs Managed Care Organizations contract
More informationCOMMUNITY MEMORIAL HOSPITAL INC. BUSINESS OFFICE POLICIES AND PROCEDURES
Document Title: Financial Assistance Policy Created: January 2016 Revised: I. Purpose: To establish policies and procedures necessary to ensure that patients of Community Memorial Hospital, who for economic
More informationSTATE OF NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH CARE FINANCING AND POLICY
STATE OF NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH CARE FINANCING AND POLICY AUDIT REPORT Table of Contents Page Executive Summary... 1 Introduction... 7 Background... 7 Scope and
More informationTalking Points in Support of Medicaid Expansion December 29, 2013
Talking Points in Support of Medicaid Expansion December 29, 2013 This document contains key talking points in favor of Medicaid expansion. The talking points are sorted by the important themes we wish
More informationhealth insurance choices before and after age 65
health insurance choices before and after age 65 NEARING RETIREMENT Over the course of your life, you ve spent hundreds of thousands of dollars on health insurance. That sounds disheartening, but it s
More informationAge to Diagnosis Code & Procedure Code Policy
Age to Diagnosis Code & Procedure Code Policy Policy Number 2017R0086C Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee You are responsible for submission of accurate
More informationCBHS Billing - Provider Bulletin. **Important Dates for 2016 Open Enrollment Period**
**Important Dates for 2016 Open Enrollment Period** Every year, there is a short window of time when people can change or enroll in a health insurance plan. This is called the Open Enrollment Period. This
More information114.6 CMR: DIVISION OF HEALTH CARE FINANCE AND POLICY MEDICAL SECURITY BUREAU
114.6 CMR 14.00: HEALTH SAFETY NET PAYMENTS AND FUNDING Section 14.01: General Provisions 14.02: Definitions 14.03: Sources and Uses of Funds 14.04: Total Hospital Assessment Liability to the Health Safety
More informationMultiCare Health System Year End 2012 Results December 31, 2012
MultiCare Health System Year End 2012 Results December 31, 2012 MultiCare Health System (MHS), a Washington nonprofit corporation, is an integrated healthcare delivery system providing inpatient, outpatient,
More informationRate Component Overview
Oxford Health Plans (NY), Inc. Oxford Health Insurance, Inc. New York Small Group POS Plans Narrative Summary of Requested Rate Changes Effective 4th quarter 2013 We have prepared this Narrative Summary
More informationPRICE TRANSPARENCY Frequently Asked Questions
PRICE TRANSPARENCY Frequently Asked Questions Introduction Price transparency is one of the most confusing topics in today s healthcare world. Healthcare consumers are becoming more engaged and asking
More informationThe Patient Protection and Affordable Care Act of 2010 (ACA)
CENTER FOR HEALTHCARE RESEARCH & TRANSFORMATION Policy Brief April 2011 Guide to State Requirements and Policy Choices in the Affordable Care Act The Patient Protection and Affordable Care Act of 2010
More informationHealth Information Technology and Management
Health Information Technology and Management CHAPTER 9 Healthcare Coding and Reimbursement Pretest (True/False) CPT-4 codes are used to bill for disease and illness. Medicare Part B provides medical insurance
More informationmedicaid and the uninsured Covering the Uninsured in 2008: Key Facts about Current Costs, Sources of Payment, and Incremental Costs
kaiser commission on K E Y F A C T S medicaid and the uninsured August 2008 Covering the in 2008: Key Facts about Current Costs, Sources of Payment, and Incremental Costs Nearly 77 million people will
More informationPocono Health System. Independent Auditor s Report and Consolidated Financial Statements
Independent Auditor s Report and Consolidated Financial Statements Contents Independent Auditor s Report... 1 Consolidated Financial Statements Balance Sheets... 3 Statements of Operations and Changes
More informationHealth Care Reform: Chapter Three. The U.S. Senate and America s Healthy Future Act
Health Care Reform: Chapter Three The U.S. Senate and America s Healthy Future Act SECA Policy Brief Initial Publication September 2009 Updated October 2009 2 The Senate Finance Committee Chairman Introduces
More informationMedicaid Payments to Medicare Advantage Plan Providers. Medicaid Program Department of Health
New York State Office of the State Comptroller Thomas P. DiNapoli Division of State Government Accountability Medicaid Payments to Medicare Advantage Plan Providers Medicaid Program Department of Health
More informationGu i dance for Grou ps
HEALTHCARE REFORM Gu i dance for Grou ps 01MK4428 5/10 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company Table of contents Overview of the Patient Protection
More informationTarrant County Hospital District d/b/a JPS Health Network A Component Unit of Tarrant County, Texas
Independent Auditor s Report and Financial Statements Years Ended Contents Independent Auditor s Report... 1 Management s Discussion and Analysis... 3 Financial Statements Balance Sheets... 9 Statements
More informationPart I SECTION The first three sections of this initiative focuses on its key objectives, and defines the terminology found throughout Part I.
Part I SECTION 101-103 The first three sections of this initiative focuses on its key objectives, and defines the terminology found throughout Part I. 101 UNIVERSAL COVERAGE PROTECTING HEALTH CARE CHOICES
More informationIf an emergency medical services agency is dispatched by. a public safety answering point, as defined in 35 Pa.C. S. 5302
(b} If an emergency medical services agency is dispatched by a public safety answering point, as defined in 35 Pa.C. S. 5302 (relating to definitions) and provides medically necessary emergency care, including
More informationPrescription Drug Expenditures and Healthcare Burdens in the Medicaid Population. G. Edward Miller, Jessica S. Banthin and Thomas M.
Prescription Drug Expenditures and Healthcare Burdens in the Medicaid Population G. Edward Miller, Jessica S. Banthin and Thomas M. Selden September 23, 2008 Health Care Financial Burdens in the Medicaid
More informationDecember COMMUNITY CHECKUP CHART PACK
December 2017 2017 COMMUNITY CHECKUP CHART PACK 2 Washington State Performance for Commercially Insured as Compared to NCQA National Benchmarks 3 Washington State Performance for Medicaid Insured as Compared
More informationNavigating The End-Stage Renal Disease (ESRD) Payment System
Navigating The End-Stage Renal Disease (ESRD) Payment System The Payment Systems Mark A. Meier, MSW, LICSW Page 1 of 10 00:00:00 Mark A. Meier: Let s now shift our focus to talk about the specifics associated
More informationUnit 4 Budgeting, Variance Analysis, and Pricing
Unit 4 Budgeting, Variance Analysis, and Pricing Learning Objectives: After completing this unit, you should understand: The value of budgets in planning and control. The use and preparation of the four
More informationFirst a word about the rising cost of retiree healthcare
Medicare Trends First a word about the rising cost of retiree healthcare The average 66-year-old couple is expected to spend nearly 60% of their Social Security income on medical bills, according to a
More informationMedi-Pak Advantage: Terms and Conditions of Provider Participation
Medi-Pak Advantage: Terms and Conditions of Provider Participation Medi-Pak Advantage is a Medicare Advantage Private Fee-For-Service plan offered by Arkansas Blue Cross and Blue Shield. Medi-Pak Advantage
More informationDraft Recommendation for Adjustment to the Differential
Draft Recommendation for Adjustment to the Differential June 13, 2018 Health Services Cost Review Commission 4160 Patterson Avenue Baltimore, Maryland 21215 (410) 764-2605 FAX: (410) 358-6217 This document
More informationIndividual Insurance
Health Insurance Health Insurance against loss by illness or bodily injury. Health Insurance provides coverage for medicine, visits to the doctor or emergency room, hospital stays and other medical expenses.
More informationNEGATIVE CONSEQUENCES OF THE OHIO PRESCRIPTION DRUG (or Rx) BALLOT ISSUE Families & Children in Medicaid, Pharmacy Services Are Impacted
NEGATIVE CONSEQUENCES OF THE OHIO PRESCRIPTION DRUG (or Rx) BALLOT ISSUE Families & Children in Medicaid, Pharmacy Services Are Impacted April 11, 2017 John McCarthy CEO, Upshur Street Consulting LLC,
More informationLiberty County Hospital& Nursing Home, Inc. dba Liberty Medical Center Administrative Manual of Policies and Procedures
Liberty County Hospital& Nursing Home, Inc. dba Liberty Medical Center Administrative Manual of Policies and Procedures SUBJECT: Payment, Billing, and Collection Policy Prepared by: Lacee Lalum, Director
More informationTarrant County Hospital District d/b/a JPS Health Network A Component Unit of Tarrant County, Texas
Independent Auditor s Report and Financial Statements Years Ended Contents Independent Auditor s Report... 1 Management s Discussion and Analysis... 3 Financial Statements Balance Sheets... 10 Statements
More informationHEALTH CARE ORGANIZATION AND FINANCING
HEALTH CARE ORGANIZATION AND FINANCING Fee for Service Care Independent physician Patient pays for care No middleman Little paperwork Fee for Service Challenges Running a business Employee relations Collections/
More informationAPPLICATION FOR ENROLLMENT
APPLICATION FOR ENROLLMENT The person completing this application should keep the copy labeled Employee Copy and carefully read the information on the reverse side regarding the Health Insurance Portability
More informationPart I _CH01_001_018.indd 1 29/01/15 3:49 PM
Part I 9781284086256_CH01_001_018.indd 1 9781284086256_CH01_001_018.indd 2 1 Introduction to Healthcare Finance Learning Outcomes After reading this chapter, the student will be able to: Identify the different
More informationPersonal Finance, 6e (Madura) Chapter 12 Health and Disability Insurance Background on Health Insurance
Personal Finance, 6e (Madura) Chapter 12 Health and Disability Insurance 12.1 Background on Health Insurance 1) Health insurance protects net worth by minimizing the chance that you will have to reduce
More informationAlameda County Board of Supervisors Health Committee s Community Dialogue on Preparing for Health Reform
Alameda County Board of Supervisors Health Committee s Community Dialogue on Preparing for Health Reform Session 1: Overview of the Affordable Care Act November 14, 2011 This session served as the kick-
More informationACA in Brief 2/18/2014. It Takes Three Branches... Overview of the Affordable Care Act. Health Insurance Coverage, USA, % 16% 55% 15% 10%
Health Insurance Coverage, USA, 2011 16% Uninsured Overview of the Affordable Care Act 55% 16% Medicaid Medicare Private Non-Group Philip R. Lee Institute for Health Policy Studies Janet Coffman, MPP,
More informationMedicare Prescription Drug, Improvement and Modernization Act
International Journal of Health Research and Innovation, vol. 1, no. 2, 2013, 13-18 ISSN: 2051-5057 (print version), 2051-5065 (online) Scienpress Ltd, 2013 Medicare Prescription Drug, Improvement and
More informationChildren s Hospital Medical Center and Affiliates
Children s Hospital Medical Center and Affiliates Title 2 U.S. Code of Federal Regulations Part 200 (Uniform Guidance) Reports For The Year Ended June 30, 2017 CHILDREN S HOSPITAL MEDICAL CENTER AND AFFILIATES
More informationHEALTH POLICY COLLOQUIUM BRIEF
Muskie School of Public Service HEALTH POLICY COLLOQUIUM BRIEF Examining MaineCare s Coverage Options Under the Affordable Care Act Erika Ziller PhD and Trish Riley, Muskie School of Public Service March
More informationHealth Care Reform Update
Updated March 9, 2011 Health Care Reform Update Health Care Reform Timeline for Employer-Sponsored Plans This timeline provides some of the key dates associated with the Patient Protection and Affordable
More informationATTENTION: NEW PATIENTS Please allow 4 to 6 weeks to receive your FIRST fill on your prescriptions.
ATTENTION: NEW PATIENTS Please allow 4 to 6 weeks to receive your FIRST fill on your prescriptions. Regional Healthcare does not control shipments of medication. The pharmaceutical company which supplies
More informationDR. FRIEDMAN FINANCIAL STUDY EXECUTIVE SUMMARY DECEMBER 2017
DR. FRIEDMAN FINANCIAL STUDY EXECUTIVE SUMMARY DECEMBER 2017 Economic Analysis of Single Payer in Washington State: Context, Savings, Costs, Financing Gerald Friedman Professor of Economics University
More informationHallmark Health Corporation and Affiliates
Hallmark Health Corporation and Affiliates Consolidated Financial Statements as of and for the Years Ended September 30, 2016 and 2015, Schedule of Expenditures of Federal Awards for the Year Ended September
More informationThe Source of Payment Typology A National Standard
The Source of Payment Typology A National Standard Presentation to ASC X12 September 29, 2015 Hetty Khan National Center for Health Statistics Agenda Background Description Purpose Uses Maintenance Background
More informationWhere does the typical health insurance dollar go?
Where does the typical health insurance dollar go? 87 13 Inpatient Services = 20 Outpatient Services = 15 Hospital Costs = 35 Based on a PricewaterhouseCoopers analysis. Factors Fueling Rising Healthcare
More informationHealth Care in Maine: An Overview
Legislative Policy Forum on Health Care February 4 th, 2011 Health Care in Maine: An Overview Wendy J. Wolf, MD, MPH President & CEO Maine Health Access Foundation www.mehaf.org Health Forum Sponsor: The
More informationMedicare for All: Leaving No One Behind
Medicare for All: Leaving No One Behind May, 206 Presidential candidate Bernie Sanders has designed a replacement for the Affordable Care Act (ACA), called Medicare for All: Leaving No One Behind. The
More informationTopic 15 Government Healthcare Spending Programs
Topic 15 Government Healthcare Spending Programs US National Healthcare Expenditure (NHCE) in 2012 amounted to $2.8 trillion (17.2% of GDP or $8915 per person). By any measure, the US spends more (total
More informationFinancial Assistance Policy
Financial Assistance Policy POLICY: Akron Children s Hospital (Children s) and its affiliates are committed to providing quality care to the patients we serve. Children s complies with the Emergency Medical
More informationCarnegie Hill Imaging for Women, PLLC Carnegie South Imaging for Women, PLLC PRACTICE BILLING POLICY IMPORTANT NOTICE TO PATIENTS
Carnegie Hill Imaging for Women, PLLC Carnegie South Imaging for Women, PLLC PRACTICE BILLING POLICY IMPORTANT NOTICE TO PATIENTS The following sets forth the general billing policy of Carnegie Hill Imaging
More informationCIRCLE THE CITY AND SUBSIDIARIES. Consolidated Financial Statements and Supplementary Information
CIRCLE THE CITY AND SUBSIDIARIES Consolidated Financial Statements and Supplementary Information Year Ended (with comparative totals for 2016) CONTENTS Page Independent Auditors' Report...1-2 Financial
More informationList of Insurance Terms and Definitions for Uniform Translation
Term actuarial value Affordable Care Act allowed charge Definition The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%,
More informationTHE QUALITY AND CHARITY CARE TRUST, INC. Auditor s Report and Financial Statements June 30, 2014 and 2013 and Supplemental Schedule for the Year
THE QUALITY AND CHARITY CARE TRUST, INC. Auditor s Report and Financial Statements June 30, 2014 and 2013 and Supplemental Schedule for the Year Ended June 30, 2014 THE QUALITY AND CHARITY CARE TRUST,
More informationISSUE BRIEF. poverty threshold ($18,769) and deep poverty if their income falls below 50 percent of the poverty threshold ($9,385).
ASPE ISSUE BRIEF FINANCIAL CONDITION AND HEALTH CARE BURDENS OF PEOPLE IN DEEP POVERTY 1 (July 16, 2015) Americans living at the bottom of the income distribution often struggle to meet their basic needs
More informationThe Financial Effects of Critical Access Hospital Conversion
The Financial Effects of Critical Access Hospital Conversion July 23, 2003 Richard Donkle, CPA Dale Gullickson, FHFMA Rural Wisconsin Health Cooperative INTRODUCTION The Balanced Budget Act of 1997 established
More informationAccessCUBICIN Enrollment Form
Services Requested REQUIRED Choose the Services that are being Requested INSTRUCTIONS FOR COMPLETING THIS FORM Patient Information REQUIRED Include the primary contact; if other than the patient, include
More informationTestimony of. Judith Feder, PhD. Before the. Committee on Oversight and Government Reform. U.S. House of Representatives.
Testimony of Judith Feder, PhD Before the Committee on Oversight and Government Reform U.S. House of Representatives December 12, 2013 Judith Feder is a professor at the Georgetown University McCourt School
More informationUnitedHealthcare Medicare Advantage Reimbursement Policy CMS 1500 Multiple Procedure Payment Reduction (MPPR) for Therapy Services Policy
Multiple Procedure Payment Reduction (MPPR) for Therapy Services Policy Policy Number Annual Approval Date 3/14/2018 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This
More informationMayo Clinic. Consolidated Financial Report December 31, 2013
Consolidated Financial Report December 31, 2013 Contents Independent Auditor s Report on the Financial Statements 1 Financial Statements Consolidated statements of financial position 2 Consolidated statements
More informationValue Based Contracting
Value Based Contracting CONCEPTS FOR THE MEDICAL PRACTICE dhgllp.com/healthcare 225 Peachtree Street NE, Suite 600 Atlanta, GA 30303 Bill Hannah PRINCIPAL Bill.Hannah@dhgllp.com 404.575.8921 Doral Davis-Jacobsen
More informationIntroduction to the US Health Care System. What the Business Development Professional Should Know
Introduction to the US Health Care System What the Business Development Professional Should Know November 2006 1 Understanding of the US Health Care System Evolution of the US health care system to its
More informationMore affordable health care that puts you in control
More affordable health care that puts you in control How mychoice helps you take control More affordable than many ACA plans on the market today Tailored support just for you Call mychoice Advisors for
More informationBilling and Collection Standard Operating Guidelines
Tuscarawas County Health Department Billing and Collection Standard Operating Guidelines Medical Clinic and Alcohol and Addiction Program Version 1.0 Effective May 11, 2018 Revision Table Date Revision
More informationPrepare to pivot: Getting ahead of ACA disruptive forces
Prepare to pivot: Getting ahead of ACA disruptive forces Despite significant uncertainty about how Congress will address Medicaid, subsidies, and the exchanges, waiting to take action is chancy and risks
More informationEASTERN CONNECTICUT HEALTH NETWORK POLICY AND PROCEDURE
TITLE: Financial Assistance Policy and Procedure Policy: 500 TOPIC Financial Assistance / Charity Care ECHN is committed to providing financial assistance to persons who have healthcare needs and are uninsured,
More informationFlorida 2016 Legislative Update House Bill 221 & House Bill 1175
Florida 2016 Legislative Update House Bill 221 & House Bill 1175 Tracy Lutz, Esquire, Managing Partner Specialized Healthcare Partners September 16, 2016 House Bill ( HB ) 221- Extends balance billing
More informationNational Health Care Reform: Impact on Oklahoma
National Health Care Reform: Impact on Oklahoma Garth L. Splinter, MD, MBA State Medicaid Director Oklahoma Health Care Authority March, 2011 www.okhca.org 1 United States Uninsured 50.7 million people
More informationCompensation and Reimbursement
492 Pharmacy Management: Compensation and Reimbursement Positions Compensation and Reimbursement Revenue Cycle Compliance and Management (1710) To encourage pharmacists to serve as leaders in the development
More information340B Drug Pricing Program
340B Drug Pricing Program Mary Stepanyan, PharmD Candidate 2018 University of Southern California, School of Pharmacy Pro Pharma Pharmaceutical Consultants Under the preceptorship of Dr. Craig Stern WHY
More informationGET THE FACTS ON QUESTION 2: Medicaid Expansion Will Help Maine
1. What is Medicaid Expansion? GET THE FACTS ON QUESTION 2: Medicaid Expansion Will Help Maine Medicaid is a federal-state health insurance program for low-income parents and children, the elderly and
More information19. Health Insurance. Introduction. Employee Participation. Plan Operators
19. Health Insurance Introduction As the cost of health care continues to climb, health insurance is becoming an increasingly valuable employee benefit. Employers view it as an integral component of the
More informationHow Bundled Payments Create Value in New Product Designs Cognizant
How Bundled Payments Create Value in New Product Designs 1 About Cognizant 2 This Will Not Take Long. 3 What is a Health Insurance Product? 4 Understanding Product Design Commercial Insurance One specific
More informationGLOSSARY. MEDICAID: A joint federal and state program that helps people with low incomes and limited resources pay health care costs.
GLOSSARY It has become obvious that those speaking about single-payer, universal healthcare and Medicare for all are using those terms interchangeably. These terms are not interchangeable and already have
More informationThe Affordable Care Act Update
The Affordable Care Act Update Presented by: The Union Labor Life Insurance Company SOLUTIONS FOR THE UNION WORKPLACE SPECIALTY INSURANCE INVESTMENTS Overview of Presentation 1. 2010 2014 Provisions overview
More informationC ONSOLIDATED F INANCIAL S TATEMENTS, R EQUIRED S UPPLEMENTARY I NFORMATION AND O THER F INANCIAL I NFORMATION
C ONSOLIDATED F INANCIAL S TATEMENTS, R EQUIRED S UPPLEMENTARY I NFORMATION AND O THER F INANCIAL I NFORMATION Nassau Health Care Corporation and Subsidiaries (Component Unit of Nassau County) Years Ended
More informationCAMC Health System, Inc. and Subsidiaries
CAMC Health System, Inc. and Subsidiaries Consolidated Financial Statements and Other Financial Information as of and for the Years Ended December 31, 2016 and 2015, and Independent Auditors Report CAMC
More informationHealth Economics Program
Health Economics Program Issue Brief November, 2010 Distribution of Health Insurance Coverage in Minnesota, 2008 The Health Economics Program of the Minnesota Department of Health monitors the Minnesota
More informationELIGIBILITY INFORMATION YOU NEED TO KNOW
EMPLOYEE BENEFITS PLAN YEAR 2017-2018 TABLE OF CONTENTS Eligibility Information You Need to Know 3 Medical Benefits / Premiums 4 Deductible Type / Alternative Prescription Drug Program 6 Arkansas Blue
More informationMISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT MAY 2016 STAFF ANALYSIS
MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT MAY 2016 CON REVIEW METHODIST LE BONHEUR HEALTHCARE CONSTRUCTION OF MEDICAL OFFICE BUILDING CAPITAL EXPENDITURE:
More informationHealth Care Reform Brings New Challenges, New Opportunities. November, 2010 Anne McLeod, Senior Vice President California Hospital Association
Health Care Reform Brings New Challenges, New Opportunities November, 2010 Anne McLeod, Senior Vice President California Hospital Association Hospitals play an important role in delivering care: Hospitals
More informationMedicaid Prescribed Drug Program Spending Control Initiatives. For the Quarter April 1, 2014 through June 30, 2014
Medicaid Prescribed Drug Program Spending Control Initiatives For the Quarter April 1, 2014 through June 30, 2014 Report to the Florida Legislature January 2015 Table of Contents Purpose of Report... 1
More information