or medical professionals and institutions, the importance of reimbursement in healthcare cannot be overstated: this is how they are paid, of course, and how they are able to continue providing services to consumers. But, as folks on both sides of the equation know, healthcare is far from simple, and neither medical decision-making nor healthcare reimbursement rates are simplethey are continually being reformed.
Ideally, healthcare providers would be able to make course-of-treatment decisions for their patients through patient symptoms, diagnosis, open discussions, and insight gleaned from the patients medical history. In other words, in an ideal world, consideration of how providers will be paid would not hinder physicians from making the soundest medical directives for the patient. However, we do not live in an ideal world, and complications in healthcare reimbursement often interfere with what may be the best course of treatment for particular patients. This is an important consideration for medical professionals, administrators, and lawmakers. However, a new trend is emerging: doctors who dont take health insurance. These providers have opted to take cash payments, set up payments plans, or offer a monthly subscription. A growing number of doctors simply are not taking contracts with insurance companies, although the concentration varies by region and by specialty. That leaves patients to pay the market rate the doctor charges, and then submit a receipt to get reimbursement for out-of-network coverage, if they have it (1).
What are the ethical implications associated with each model? If you were the business office manager of a small practice, which payment model would you prefer and why? For this activity, you will choose an organization to research and create questions to ask as part of that research.
Instructions
Your Week 3 assignment ask you to research the financial condition for a specific healthcare organization of your choice. You will need to submit a Microsoft Word document with each of the following:
Use the Strayer Libraryor another verified sourceto identify a healthcare organization of interest. This should be 12 sentences that clearly identify the chosen healthcare organization and provide a high-level overview of what kind of organization it is and who the organization serves.
You will want to be sure there is plenty of information available about the organization, particularly financial information. This means youll likely need to choose a large organization that is required to make financials public.
To gain a better understanding of the financial condition of your chosen healthcare organization, its budget preparation process, and fiscal planning strategies, you will develop five questions that you will answer as part of your research. Ideally, these would be questions you would ask a management official responsible for the financial planning for the organization. Provide a rationale for the questions you chose.
Think about questions that will give you insight into what the company looks for when preparing their yearly budget, their fiscal planning strategies, and how they monitor their financial condition throughout the year and make adjustments as needed.
Note: You may also choose to use these questions to interview a financial manager within a healthcare organization. The interview would then be the source of your information instead of the research.
