Business Finance
Health Care Reimbursement and Payment Methods Evaluation Questions

Question Description

Assessment Instructions

Write a 10-page assessment of current health care reimbursement policies and their effect on financial management decisions at one type of health care site, such as a surgery center or an acute care hospital. In this paper, address the following:

  • Evaluate the health care reimbursement and payment methods for the type of health care site you have chosen to examine.
  • Examine both government and non-government payment methods.
  • Evaluate how these methods affect revenue-cycle management and financial responses at this type of site.

Support your assessment with at least 10 references from the scholarly or professional literature of the field. You are encouraged to conduct supplemental research to find appropriate resources; however, you may use the readings that have been recommended in this course to satisfy the 10-reference requirement. Include a title page and table of contents in your paper.

Additional Requirements

  • Written communication: Written communication should be free of errors that detract from the overall message.
  • APA formatting: References and citations should be formatted according to APA (6th edition) style and formatting.
  • Resources: A minimum of 10 references, all cited in the body of the text.
  • Paper length: A minimum of 10 pages, excluding a title page, table of contents, and references list.
  • Font and font size: Times New Roman, 12-point.

Health Care Reimbursement and Payment Methods Evaluation Questions

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Final Answer



Current Reimbursement in Health Care
Institution Affiliation




Health care reimbursement
Costs in hospitals are a significant part of the total charges in healthcare. The methods of
payment in hospitals may include incentives that are likely to influence the decisions made by an
organization and as a result, can affect care provision in hospitals. Healthcare providers ought to
be given incentives to give care that will maximize the benefit of the patients as patients usually
depend on decisions made by health care providers. To ensure that hospitals utilize resources
more adequately, aiming to contain costs, policies on methods of reimbursement need to be
prepared. The methods of payment are usually are based on information obtained from economic
models where patients demand health and medical and health care providers offer it. Changes in
the ways of payment in hospitals, healthcare costs, and quality of care are, however difficult to
predict. To get better value for investments in health care, it is significant to streamline
incentives in health and economics to achieve the goals. The incentives should focus on the
results and value of health care offered.
Health care reimbursement and payment methods in an Acute Care Hospital
One way of compensation is fee-for-service, also known as the pay-per procedure. The
method is non-government, and it involves payment per a given procedure. The reimbursements
for each procedure are mainly prices that are in the market, or a charge list is provided for a
single procedure or a set of procedures. An assumption has been made that this method may
bring about the delivery of more services than those that are required. It also has a risk of doctorinduced demand due to the asymmetry of information between the providers and the patients,
which may have an effect that is a negative quality of care offered, leading to oversupply. There
are no incentives that can limit the use of resources. Besides, the cost may be elevated since there
is the incentive of recoding into a higher cost band (Delattre, 2003).



This method allows for proper revenue-cycle management and financial responses since
hospitals are even likely to offer more services as long as the patient is willing to pay for them,
thus generating more revenue. It is also possible to make financial management decisions as the
acute care hospital will have collected revenue as they offer the service.
The second method of payment, which is also non-government, is self-pay where patients pay
for their medical care from their own pockets. The patients are billed as per the rates that are
published for various services. The patients are also given a chance to negotiate for a discounted
different price or method of payment with the hospital.
The disadvantage is that the discounts that are given to a patient who pays for self by the
hospitals are between 3% to 10% as compared to the 20 to 30% that is given to managed care
payers. Self-pay method of reimbursement affects financial management decisions negatively as
it may be a challenge to for instance prepare a budget for the hospital while patients are still
hospitalized since one may not tell whether they will pay or not. The method also has an impact
on revenue cycle management and financial responses as sometimes the patients are not able to
clear the entire hospital bill at once, therefore making it difficult for the hospital to plan its
finances appropriately.
Medicare is a health insurance program that was established by the government under the
social security Act under Title II, for persons who are aged to act as a compliment for retirees,
survivors, and beneficiaries of disability insurance. It is a government method of payment which
constitutes of Hospital insurance which caters for in-patient care, home health, facilities of
skilled nursing, and hospice care. All services offered by a hospital are included in in-patient
care, which includes meals, semi-private accommodations, and laboratory procedures. The
method also has supplementary Medical Insurance, which helps pay for outpatient, physician,



and home health care. Patients are required to make payment in advance through a monthly
premium. Hospitals are, in turn, r...

nkostas (29612)
Cornell University

Return customer, been using sp for a good two years now.

Thanks as always for the good work!

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