Financial Management in Healthcare
Medicare and Medicaid are programs run by the government and which provide medical services as well as services that are health care related to particular groups of individuals in the United States. It is imperative to note that these two programs are exceedingly dissimilar but are supervised and overseen by the Centers for Medicare and Medicaid Services which is a department that is found within the Department of Health and Human Services of the United States. The origin of these two programs dates back to the year 1965 when they were created after President Lyndon B. Johnson signed changes to the Social Security Act (Crosta, 2015) for the national health care program. This program was principally created at the time when individuals who were aged 65 years and above found it impossible to obtain private coverage for health insurance. In particular, this was a time when the major financial and economic concern was that an illness might send someone to the hospital and thereafter bring about immense bills. In addition, at the time there was no extensive use of prescriptive medication to cure illnesses., Medicare, on the other hand, has created accessibility to healthcare a basic right for each American once they attain the age of 65. For this reason, the health status and longevity of old citizens of the U.S. has greatly improved (National Academy of Social Insurance, n.d).
Medicaid is a health and medical services program that is entitled to particular individuals and also households that have low income and minimal resources. The main management and oversight of the program is done at the federal level. However, every state institutes the rate of payment, the standards of being eligible, and also oversees its own Medicaid program. On the other hand, Medicare is a medical health insurance program done at the federal level which pays for hospital services expenses and medical care for elderly individuals and disabled individuals in the United States. Medicare consists of four main parts. The first two, Part A and Part B, are for hospital insurance and medical insurance respectively. The other two parts, Part C, and Part D are custom care medical plans and prescription drug plans respectively (Crosta, 2015).
Physicians are reimbursed for providing services to Medicare and Medicaid patients in different ways. Medicare reimburses for inpatient medical and health services under its Inpatient Prospective Payment System (IPPS). The IPPS is referred to as prospective for the reason that instead of remunerating for every service centered on what the charges of the hospital, the rate has been fixed beforehand. The IPPS employs diagnosis-related groups (DRGs) to categorize patients into parallel treatment and period of hospital stay units and thereafter institutes prices for every categorical group. The physical location of a hospital, expenses on supply and labor influence the DRG compensation rate discussed with CMS. Hospitals are given the prearranged DRG sum irrespective of the real charge of care, even though alterations might be prepared in some cases (Magovern & Jurek, 2009). On the other hand, the Medicare Outpatient Prospective Payment System (OPPS) is utilized to recompense hospitals for health services to Medicare patients that are delivered on an outpatient context. These services include the majority of Part B Medicare services which is medical insurance. Similar to IPPS, the OPPS is centered on a future compensation system that makes use of a valuing unit known as the ambulatory payment classification (APC). These are apportioned for every outpatient practice, service, or entry. The full compensation the hospital obtains for the visit is calculated as the summation of the individual APC outflows for every service (Magovern & Jurek, 2009).
References
Magovern, S., Jurek, J. (2009). Hospital Billing. New York: McGraw-Hill Publishers.
Crosta, P. (2015). What is Medicare / Medicaid? Medical News Today. Retrieved 5 October 2015 from http://www.medicalnewstoday.com/info/medicare-medicaid/
National Academy of Social Insurance. (n.d). What is the History of Medicare? Retrieved 5 October 2015 from https://www.nasi.org/learn/medicare/history
Question 4
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