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5 pages/β‰ˆ1375 words
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4 Sources
Style:
APA
Subject:
Health, Medicine, Nursing
Type:
Research Paper
Language:
English (U.S.)
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Topic:

Examining Healthcare Reimbursement Systems

Research Paper Instructions:

COMPETENCIES
7052.2.1 : Reimbursement Methodologies
The graduate analyzes contemporary healthcare reimbursement methodologies and systems used in the United States.
7052.2.3 : Government-Sponsored Healthcare Programs
The graduate analyzes how government policies impact various government-sponsored healthcare programs.
7052.2.4 : Reimbursement Systems
The graduate analyzes how third-party reimbursement payment calculations impact reimbursement in healthcare organizations.
INTRODUCTION
The healthcare reimbursement systems in the United States are complex. A healthcare professional needs an understanding of the basic principles of the third-party payer system and the many options that are available to citizens through government-funded healthcare programs. Private and commercial insurance companies offer a different menu of options to their clients. All third-party payers are interested in decreasing healthcare costs while improving quality and controlling access to unneeded services.
In this task, you will examine the complexity of the healthcare reimbursement systems and begin to compare the similarities and differences between them. To complete this task, you will discuss each type of healthcare insurance plan listed, as well as the plan components, reimbursement provisions, restrictions, and the impact of government regulations.
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The originality report that is provided when you submit your task can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Discuss the components of each of the following insurance plans:
• Fee for service (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 savings accounts

B. Discuss the restrictions of each of the following insurance plans:
• Fee for service (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 savings accounts

C. Discuss the reimbursement process for each of the following insurance plans:
• Fee for service (indemnity) plans
• Managed care plans
• Government-sponsored health plans (i.e., Medicaid, State Children’s Health Insurance Program (SCHIP), Military/TRICARE, Indian Health Service).
• High-deductible health plans/healthcare savings accounts

D. Discuss the inpatient and outpatient reimbursement processes for Medicare.

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 healthcare organizations.

G. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

H. Demonstrate professional communication in the content and presentation of your submission.
***writer.....no minimum or maximum of references, WGU just expects good judgement of referencing information.
****Tony, reminder that you were going to waive the plagiarism check fee.

Research Paper Sample Content Preview:

Healthcare Reimbursement Systems
Student's Name
Department, Institutional Affiliation
Course Name and Number
Professor's Name
Date
Healthcare Reimbursement Systems
In the United States, the healthcare reimbursement processes are complicated. A healthcare practitioner should be familiar with the fundamentals of the third-party payer system and the numerous options offered to citizens through government-funded health programs. Clients can choose from various choices provided by private and commercial insurance firms. All third-party payers want to save healthcare costs while enhancing the quality and limiting access to unnecessary services.
Components of Insurance Plans
It is evident that insurance plans have distinctive components. For instance, subscribers in a Fee for Service (FFS) plan select a specialist or other healthcare expert, and the insurance covers the bulk of the cost. Unlike other plans, a fee-for-service plan often provides ingress to the largest number of medical providers, restricting ingress to some providers (Chalasani&Koritala, 2019). Fundamental protection includes paying for frequently performed hospitalization, doctor visits, surgery, and health care; and Major Medical, which usually covers expenditures incurred in the course of a chronic illness or a serious injury.
Nonetheless, components of managed care plan include consumption assessment and provider channels. Diagnostic procedures and superfluous medications are screened out during consumption assessment (Chalasani & Koritala, 2019). The screening can be performed by the insurance institution's medical team (utilizing generally recognized medical professional standards) to ensure that the therapy is patient-centered and administered in the cheapest way imaginable (Zuvekas, 2020). Approaches like prequalification of hospitalizations and procedures, assessment of medication provided, and intervention for patients requiring high degree care are used to achieve this objective. However, this is different from government-sponsored health plans.
Older people, low-income women and kids, disabled people, veterans, active-duty soldiers, and their families are the ones covered by government-sponsored health plans. Some of these initiatives— the State Children's Health Insurance Program (SCHIP), Medicare, and Medicaid —were created for those with high chronic conditions and low income. However, the healthcare system has consistently struggled to function (Stoddard-Dare et al., 2018). The remaining initiatives, DOD TRICARE, VHA, and IHS, cater to different demographics whom the national government has a positive connection: military people and their families, veterans.
Additionally, a High Deductible Health Plan (HDHP) is health insurance that includes conventional medic, a Health Reimbursement Arrangement (HRA), and a tax-privileged manner to provide for prospective healthcare fees while giving the patient flexibility and discernment over how the patient spend the healthcare resources currently (Chalasani & Koritala, 2019). Other Federal Employees Health Benefits (FEHB) Scheme policies offer lower yearly deductibles than HDHPs.
Restrictions of Insurance Plans
Regarding restrictions on the Fee for Service pl...
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