Financial and Economic Basics (revenue Streams) Healthcare FinancingEssay Preview: Financial and Economic Basics (revenue Streams) Healthcare FinancingReport this essayIn my experience as a long term care nurse I have dealt with Medicare, Medicaid, VA and private insurances and private pay for payment or reimbursement of healthcare services.
Revenue is the earned capital by a (in this case) healthcare group or provider; it can be medical services, hospice, hospital, clinic, home health or therapy services and even durable medical supplies: that is, it can be the tangible or predicted cash inflow for the business of healthcare. In health care, income is customarily received by providing some type of health care related amenities to patients.
Revenue flows into the healthcare business and is sometimes referred to as the revenue stream (Baker and Baker).Revenue is the price of services provided, stated as the healthcare full pre-determined charges. For example, hospital As full pre-determined charge for an appendectomy may be $2,000 but Giant Health Plan bargained a controlled care agreement whereby the plan (insurance) pays only $1895 for that procedure, the patient is then responsible for the remained $105. The income number (the full pre-determined charge is $2000.The hospital will collect the $1895 from the insurance company and bill the patient for the $105. The $1895 is money the hospital can count on as income; income can be accepted in the form of cash or credit. Insurance help pay the medical bills incurred by patients. Usually the large part of the bill is covered by the insurance and leaving a 10 to 20 percent for the patient (Baker and Baker, 2011).
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Insurance in Medicare
Insurance is a payment (or an insurance premium) paid for patient care (such as through a Medicare-contributory insurance program, where the cost of care provided is a dependent of income or a risk factor or other factors that the individual considers relevant or must be included in each individual’s income). The amount of any insurance benefits paid by the patient is included as insurance income and may be the result of being on Medicare or being a risk factor (such as Medicare premiums for procedures and patients are included as insurance cost). Insurance benefit means anything a physician is willing to cover for a particular problem. An insurance premium means the cost of medical care paid for by a patient in respect of which the insured takes action to take care of a patient. An insurance premium is not a personal or private amount paid to an insured. However, in a situation where the insurer has a policy obligation to provide insurance in a way that is reasonable to the insured but the insured is willing to take an alternative insurance, an insurance premium may well be paid by the insured, or by the insured’s representative to another insured.The insurance premium for a Medicare beneficiary is usually the same, although there is one major difference: the Medicare beneficiary pays the insurance premium in the form that includes all of the costs of medical care paid to the beneficiary.
Obamacare’s Coverage of the Childfree Program
At least some portion of the cost of health insurance is covered through the childfree enrollment program which is a public benefit program to help people obtain coverage for low-income, low-income, minority, and elderly people in the community. (The health insurance program is administered by the Centers for Medicare and Medicaid Services under the Affordable Care Act.) Under the childfree program, there is little or no penalty for people who are covered by an insurance plan. Children under 16 pay no additional taxes on the amounts they receive. By comparison, the state-based Medicare Payment Advisory Commission (PMAC), who provide guidance to state, local, and Tribal governments on how to participate in the community childfree program, lists these children under 13 under Medicaid as beneficiaries covered by the childfree program as much as $3,500 per person.
Federal health reform
Obamacare requires that all states, federal and state, and local governments subject to the Children’s Health Insurance Program (CHIP) do certain things in order to provide coverage for the children. These are: The Children’s Health Care Program, under Obamacare, is funded by the Food, Drug, and Cosmetic Act of 2010 under the Public Health Service Act. The Medicaid-contributory Children’s Protection Act of 2003 (PATH Act) allows states to create federally funded programs that cover all children (rather than only limited family members of beneficiaries) for the Children’s Health Care Programs (CHPs). This does not mean that the CHPs are not covered. However, state and local governments need to make specific determinations (and often the actions through which they make those determinations) as to which coverage must be provided as necessary to meet the purposes of these programs: Health Care coverage: the Children’s Children’s Health Insurance Benefit Program is designed to provide coverage for the children to the extent that the program is needed to comply with the applicable federal health reform requirements. A program may provide medical services (particularly home treatment, and outpatient care for those caring for low-birth-weight children and their families), and the cost is fixed or reduced based on the value of the care paid to the person (the cost of treating the child in the care of the family for her or
Liability Insurance (Government based insurance)Medicare is generally insurance coverage for people age 65 and over. However, others that may qualify for Medicare benefits are those with a disability under age 65, or those with certain medical conditions such as kidney fail receiving dialysis or had renal transplant (CMS).
Medicare has 5 parts the two most important parts are Part A (hospital coverage) and part B (outpatient services).Part A is the hospital coverage part of Medicare, and is not an optional for Medicare recipients. Most a hospital bill (80%) is paid by Medicare. The Social Security the hospital insurance monthly premium from the monthly SOC SEC check and directs it to a Medicare Trust Fund. Medicare has deductibles like any insurance program. As of 2000, the share of hospital payment for Medicare recipients was $776 for a hospital stay of 1 to 60 days. A recipient can expect a semiprivate room, meals, general nursing, and other health services while in the hospital (CMS).. Following discharge a patient can expect Part A to pay for outpatient services if they are needed, such as home health care under certain conditions, durable medical equipment (wheelchairs, hospital beds, oxygen, and walkers), hospice care, and blood transfusions (CMS).
The ACA’s medical assistance laws create the unique situation of a “compensatory” program. The ACA’s medical assistance laws authorize the State of Illinois to administer the Affordable Care Act (ACA) in conjunction with a variety of other federal entities. If the State does not have or is unable to provide full coverage, then the ACA provides the private health insurance program (PPP). Other states cover the Medicare Advantage and SCHIP (as well as CHIP) program in addition to the private health insurance program (PP. The ACA provides an incentive to expand the private health insurance program so that people with pre-existing conditions and those with a medical condition that requires pre-existing conditions are eligible for comprehensive coverage of a specific type of PPP. In states with these programs, the ACA provides for the full participation of the Public Health Service and other State health offices that are covered by other federal programs. To be part of this program, a recipient is required to make a $4,000 annual payments. The ACA provides that an individual shall be eligible for a payment on a dollar-for-dollar basis until: (1) they have received full coverage under an agreement to begin with; or (2) in a case where the payments exceed $1,000 a month.
Medicaid enrollment is based on the amount of coverage at the end of each year after the first month of enrollment. During a full year (e.g., a month following an enrollment period or when all the enrollees have enrolled) the Medicare benefit may become phased out (e.g., if no Medicaid enrollment lasts through the end of the individual’s first full year of enrollment). If a full year is the end of the individual’s first full year of enrollment it will result in one of three different outcomes. The first result is determined by how many people have enrolled through the end of the individual’s first full year of coverage. The second outcome is determined by how many more people have enrolled through the end of the individual’s first full year of coverage. The third result will be determined by how many more people have enrolled through the end of the individual’s first full year of coverage.
At some time after the individual has been diagnosed a new PPP enrollee is required to make a one-year monthly payment on the dollar signer’s medical records.
The cost of health insurance under the individual plan is fixed based on the amount of coverage for the individual under the plan. The annual penalty provided is based upon the following sources:
Benefits from the employer’s Medicare plans: Medicare or the plan’s premium plans.
Taxes paid by the individual: the amount of taxable income paid to the government. The following federal benefit:
The employer’s Social Security benefits or disability plan.
If the individual is enrolled in a Medicare Advantage plan, the employer will be exempt from the tax benefits for Social Security and Medicare credits. The total benefits paid to the plan under the individual plan are based on the amount paid by the individual through the end of the previous year. (Other Social Security benefits are exempt from the tax credits because they have a tax-exempt status, including the Medicare trust fund.) Each benefit under the plan is related to cost sharing. The employer will receive a portion of the tax credits of the program over the same amount on the previous year in the form of the payroll tax deduction, as described under Part B of the federal law, and the employer’s cost sharing payments under Part C of H.R. 466 and Part D of H.R. 553. This tax bill is paid in the same way as the individual contribution to Medicare and the tax credits provided under
Part B. This part of Medicare is optional, and a recipient can choose to wave this part. However part B pays physician services, laboratory, outpatient medical and surgical services, supplies, and outpatient hospital services, therapy services under appropriate conditions, patients as well as home health care, DME, and hospice services(CMS),. This is not a100% coverage, only 80% after a $100.00 deductible has been satisfied. This 20% is a “gap,” so to fill the gap most seniors will opt to take a second insurance policy, a commercial insurance such as AARP that will cover the remaining balance that Medicare does not cover (CMS).
There are two specialty groups that oversee how Medicare benefits are utilizedPeer Review Organizations (PRO). The federal government compensates health care experts to keep an eye on and enhance care provided to recipients of Medicare. This group reviews complaints related to as care received at a hospital, or other healthcare providers such as outpatient clinic, nursing home, ambulatory surgery centers, or home health agency, or from Medicare managed care plans (Example Humana Gold Plans) (CMS).
Financial In-between: Insurance Houses are appointed by the federal government to pay all Medicare Part A and Part B bills, the federal government contracts with different companies such a Blue Cross and Blue Shield to pay the bills (CMS).
Medicaid is a health care program (liability insurance) that is a government-funded (subsidized) by the U.S. federal and state government that reimburses for the medical expenses pay medical cost for those who are unable. Main management of this program is to handled medical cost at the federal level, however, each state can:
Determines its own criteria to determine who is appropriate to receive servicesRegulates the kind, quantity, length, and range of servicesEstablishes how much will be paid for servicesControls its individual Medicaid program.What services are provided with Medicaid?Every state establishes its individual Medicaid appropriateness guidelines. The Medicaid program (public health program) is designed to provide low income individuals or families with medical coverage, however, eligibility depends on meeting requirements based on age, pregnancy status, disability status, other assets, and citizenship.
Each states is the final decision maker in regards to their Medicaid programs coverage, however each states has to meet certain fixed federal conditions mandated in order to receive federal matching funds. Included are the following Mandates according to Medical News Today;