discussion response help please

Oct 5th, 2015
Price: $10 USD

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#1)   Diminishing the quantity of uninsured is a key objective of the Affordable Care Act (ACA), which gives Medicaid scope to some low-pay people in expresses that grow and Marketplace appropriations for people underneath 400% of the destitution line. Standard assessments demonstrate that more than 41 million people were uninsured in 2013, before the beginning of the major ACA scope procurements, and early confirmation recommends that the ACA has lessened this number. I believe that Mr. Smith fits the regular profile of an uninsured individual in the United States. He has two employments and not have protection in light of the fact that he can't bear the cost of it. This is extremely regular among numerous uninsured Americans today. Numerous individuals in America will work and work and attempt and disregard or treat their medical issues until it's past the point of no return or something extreme happens, for example, with Mr. Smith.

 In Mr. Smith’s case, since he does have two part-time jobs, there might be a discounted rate on the medical accommodations rendered where he will have to pay a certain amount or some kind of financial available will be offered to him. If he is in the state of impecuniosity level where he cannot pay at all, it would be indicted off as charity care.

To mitigate the effects of the financial impact, my organization can reduce cost as much as possible. What I mean by this statement is, I would reduce working hours, but try to avoid a lay-off, since it will need them when the economy comes back again. I will create a voluntarily program for workers who want to stay home, or come to work 2-3 days a week. I would also create more sub-departments, such as certain staff members only to handle a case from entry to exit only, reduce the workload on the individuals currently scheduled by not stretching them out. 



In my experience, when you are hired part time that most likely means you do not have health insurance through work. Even with Joe working 2 jobs, both being part time that means odds are that he either has his own separate health insurance or he has none at all. There is Medicaid, but that is usually for females and children or pregnant women, and the elderly 60 and older, so I don’t think he qualifies for that either and even if he did meet the criteria he would be making to much a month. If Joe does not have health insurance, he is definitely going to get billed from the hospital and emergency room. The bills from the emergency rooms and urgent care are not cheap at all. Depending on if the amount if feasible for Joe, if he doesn’t try to pay for any of the balance then it will eventually go to collections and in turn effect his credit negatively

With that all being said I would say the situation of Joe going to the hospital and not being insured is typical, but for the fact that he has two jobs and doesn’t have some kind of affordable insurance, that part doesn’t seem right. I think something helpful would be for more income based clinics to e opened. There is one in my area that I go to actually because I don’t have insurance, which I will be getting Medicaid soon. This clinic goes off of how much you are paid. For my visit I go a bill I the mail for as much as $13.00 that’s it. The clinic pretty much did the same thing an emergency room would have done for me.

A lot has changed within the health system an health coverage, especially since the Affordable Care Act. This article states exactly what we are talking about and the issue that Joe is dealing with, along with myself and many others.

“Until recently, estimates indicated that more than half of Americans obtain health insurance through their employers. Yet the employer-based system leaves many vulnerable populations, such as low-wage and part-time workers, without coverage. The changes authorized by the Affordable Care Act (2010), and in particular the Health Insurance Marketplace (also known as health insurance exchanges), which became operational in 2014, are projected to have a substantial impact on the provision of employer-based health care coverage



According to Baack& Fischer (2013) there are three methods of payments, Insurance with the employer, government issued insurance and those programs are Medicaid and Medicare or those who purchase their own individual insurance. The government reimburses health care facilities for those who receive Medicaid or the elderly who receives Medicare.  Those reimbursements are based on how the coders have coded the diagnosis and then the biller bills it out to get paid.  The coders are now working with the ICD -10 as oppose to the ICD-9.  The coders have to be code this diagnosis correctly so that the bill does not reject and this why as of October 1st they rolled out the new ICD – 10 because it covers a wide range of diagnosis.

The government only pays pennies on a dollar for reimbursement of services, that is why it is important to code correctly when billing, because the government at any time will audit and if they find that the coding or billing was incorrectly they will take their money back. According to our text book Medicaid has what is called the federal matching funds to states for costs of the healthcare providers. (Baack & Fischer, 2013).

When we talk about the different services that are offered at hospital and what the affects are when it comes to expenses, then we begin to speak about revenue cycle and the CFO.  These two persons play a major part with one another because if any bill rejects for non payment because of coding, not getting an authorization in a timely manner or the insurance states that they are out of network, then that person who’s in charge of revenue cycle talks with the CFO and they begin to write appeals to get paid for the services rendered to the patient.



Health care financial management is complex and an effective health care administrator must understand what makes up the foundation to financial operations.  This includes: health insurance (private and social) and reimbursements, private vs. not-for profit entities, costs and expenditures, capital, materials management, and budgeting. 

The major categories for reimbursements and costs in a health care organization are fee-for-service and prepayment plans.  “A fee-for-service form of coverage provides a set of benefits with which the insured can obtain medical services. Then the insurer pays the provider for that service. The insured can choose the doctor, hospital, or clinic, and the insurance pays for part or all of the cost, according to a schedule spelled out in the policy.  Fee-for-service coverage may be offered at group rates through an employer or through an affinity group, such as a trade association. It may also be offered at individual rates. Whether offered at group or individual rates, this type of coverage remains the most expensive kind of health insurance (http://bcbs.com). In contrast, the type of coverage known as a prepayment plan establishes a fixed, prespecified payment system for services. The insured can then obtain healthcare services with small copayments for office visits and some prescriptions. Prepayment plans are less expensive and are widely used in employment situations.” (Baack, 2015)

In addition to the reimbursement methods available, patient will consider the cost vs care which ultimately will affect expenses and revenue.  Some individuals will spare no expense when it comes to their health.  This can determine if a patient allows the local inexpensive hospital who has subpar care or the expensive hospital that is further away with top notch care receives will be selected for their care.  At the end of the day the goal is (whether it is a not-for-profit or for-profit organization), they must generate profits to keep the doors open for business.

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