Health Management

Health Management

The primary difference between fee-for-service and capitation reimbursement is the approach to paying. The free-for-service method involves the compensation for medical providers based upon the performed services (Adida, Mamani & Nassiri, 2017). Such services include tests or treatment procedures provided to the patient. This method predisposes no fixed payments. Nevertheless, some of the patients underline the effectiveness of FFS due to a wide range of services.

The main essence of the capitation reimbursement method is in the fixed amount per patient provided by the health insurer or physician association. Thus, the primary care physician gets the payment for the enrolled patients even when the patient does not seek treatment. The method is beneficial in reducing the overall healthcare costs due to placing a limit reimbursement offered for specific types of care (Paul III et al., 2014). In this paper, the following questions will be answered. pective and retrospective difference in terms of payment, DRG  system of payment. The Meaning of Revenue Cycle and its involvement. Finally on the distinction between bad debt and charity care.

         difference between prospective  and retrospective payment

Retrospective Payment systems deal with fees that are made after services rendered as in a fee-for-service reimbursement. This is meant that after health care services were provided, health care providers and physicians received payment for actual charges as opposed to a set fee or flat rate.

Retrospective Payment systems deal with payments that are made after services rendered as in a fee-for-service reimbursement. This is meant that after health care services were provided, health care providers and physicians received payment for actual charges as opposed to a set fee or flat rate.

DRG payment method in inpatient Medicare patients

DRG, or diagnostic related grouping, is whereby Medicare and remarkable healthcare payer organizations are classifying separate hospitalization charges and limit the amount to settle for a patient’s hospital visit. Preferably than paying the hospital for what it spent caring for a hospitalized inpatient, Medicare gives the hospital a determined amount based on the patient’s DRG and diagnosis.

                    Revenue Cycle 

The revenue cycle is defined as all managerial and medical roles that add to the recovery, administration, and group of patient service revenue. In the most simplistic and fundamental terms, this is the whole life of a patient record from creation to payment. A normal revenue cycle should follow billing and group best practices to guarantee bills are offered by following payer requirements, and all services rendered are booked. Lastly, healthcare organization requirements are to deliver services and not be paid. New IRS Form 990 Schedule H asks that hospitals evaluate the amount of debt

attributed to patients qualified for financial support. Due to these assessments and the required waiting times, it is essential than ever to trace all of your billing and response.

                       bad debt and charity care.

When patients have a hard time funding for services provided by hospitals, they fall into the class of uncompensated care which comprised of charity

care and bad debt services (White & Eijjkholt, 2015).

Following governmental and state regulation, some hospitals are restricted to render specific types of medical care at comparatively no cost when they suit particular standards, which is known as charity care. Hospitals typically will define a patient’s qualification for charity care before providing any services.  To qualify for charity care, one has to be uninsured, below the governmental poverty line, and not currently using Medicaid/ Medicare. Charity care will only meet medically essential treatments, like ER visits and inpatient hospital care. The qualification process for getting charity care does differ depending on the equipment .each hospital has its own set of laws.

Unlike charity care, bad debt occurs in cases where patients do not fit for financial aid nor claimed for it. The distinction between the two is, lousy debt occurs when a patient is reluctant to pay their charges, yet they are financially competent in fulfilling it. When an account is past due or has gone into collections, at this point, the report gets placed into the outstanding accounts receivable (Epstein & Schneider 2014). Today, lousy or bad debit for a healthcare organization is displayed as a deduction from income in a line item called Allowance for bad debt (Epstein & Schneider 2014). Unlike bad/lousy debt, charity care is not reported on the income revenue statement.

In conclusion, behind every great hospital or medical custom are health care administrators who put things flowing. Health care administrators are accountable for supervising fields such as quality of care and budgeting. Because hospitals and physicians’ exercises have a high profile, healthcare management gives daily timeliness to create diversity in the community.