Using as reference 

 

• Glandon, G. L., Slovensky, D. J., & Smaltz, D. H. (2014). Information Systems for Healthcare Management. Chicago, IL: Health Administration Press.Chapter 13 “HIT Value Analysis”
• Brown, G. D., Pasupathy, K. S., & Patrick, T. B. (2012). Health Informatics : A Systems Perspective. Chicago, Ill: Health Administration Press.Chapter 14 “Strategic Valuation of Enterprise Information Technology Architecture”
• Bullard, K. L. (2016). Cost-Effective Staffing for an EHR Implementation. Nursing Economic$, 34(2), 72-76.

In not less than 200 respond  

Imagine you are employed as an account professional in a health care organization. Which type of health insurance do you feel would be the most challenging to submit for reimbursement and in obtaining cooperation in obtaining payment? 

In two different paragraph using their references give your personal opinion to  Samantha Thompson and  Marivette Bedoya 

 Marivette Bedoya 

There are many different types of insurance plans, HMO, PPO, POS, and EPO, all of these are managed healthcare plans. Each type of health insurance plan will offer different options to obtain services, these services are obtained through a network (Horvath, 2019). The health insurance network or service providers associated with your plan can make a difference for you because it may limit which doctors you can visit, or where you can get service.

Managed care plans work better for the individual person because in the long run they are more cost effective. Indemnity/reimbursement plans will usually see more out-of-pocket charges (deductibles and co-payments) and they many times place caps on the amount of benefits you can receive over the course of your lifetime. Indemnity plans give you more freedom or flexibility, than managed care plans do in terms of using the healthcare provider of your choosing. So, depending on what a person wants, the choice between managed care and indemnity plans ultimately depends on your personal circumstances and preferences.If your goal is to minimize costs, you’re probably better off with a managed care plan.

References:

Horvath, S. (2019, October 1). What is Health Insurance? Retrieved from https://www.benzinga.com/money/what-is-health-insurance/

 

 Samantha Thompson 

The following are the top 3 reasons that a practice doesn’t get paid for services performed.

“The patient isn’t eligible for the service provided. With the changing landscape of health insurance coverage, individuals and employees change insurance frequently, or key items in their coverage are excluded by their new plan. Demographic or other identifying information for the patient is missing or incorrect; this includes the spelling of the patient’s name, their exact address, Social Security number, and birth date, among other data.The codes and modifiers on the claim form do not conform to the requirements of the patient’s insurance plan” (Medscape,2020). I believe that getting reimbursement from State covered insurance (Medicaid) is the most difficult. Medicaid has its own rules on what it deems medically necessary. Many times there is a formulary that dictates the way the person needs to be treated and that doesn’t sit well with the doctors because they have their own plan of care. However if the doctor deviates from the State mandated plan to prove that their plan is the correct course of action, Medicaid will not pay and the patient is stuck with the hefty bill or the practice has to write the services off.

References:

Medscape, (2020). Collecting Effectively through Third Party Payers and Patients. Retrieved from: https://www.medscape.com/courses/section/870036