Prompt 1: Reimbursement
The provision of healthcare services occurs uniquely. The field is highly specialized, with a handful of practitioners in each area (Flanagan, 2014). Most patients are also not fully insured while it is hard to judge the quality of competing services. Finally, the decision on the services to purchase is made by the consumer alongside the physician. The healthcare reimbursement methodologies are the insurance practices offered to people. They include third-party payers who are insurance companies that pay for part or all of the patients’ fee (Flanagan, 2014). Under these third-party payers are private insurers who are inclusive of Blue Cross and blue shield, self-insurers and commercial insurance. Another form is the public insurers are either given by the government or offered by direct providers of healthcare, including Medicaid and Medicare (Flanagan, 2014). There are also managed care plans that combine the function of insurance and the provision of healthcare, such as the Health Maintenance Organization (HMO).
Prompt 2: Reform and reimbursement
Projected effects of healthcare reform on healthcare reimbursement
Insurance coverage has been a long contested issue for some time; thus, the ACA came up with several provisions to expand insurance coverage plans. They were geared at reducing cost and making healthcare affordable (Anderson, 2014). The number of standards increased while health insurance exchange was made possible among other reforms. The projected effects of the healthcare reform on healthcare reimbursement is that there will be an increased number of citizens and legal residents will receive coverage through public insurance (Anderson, 2014). This will result in an increased number of people who can afford managed care, thus increasing the amount of healthcare reimbursement. There will also be an increase in the number of consumers getting high-deductible health plans as their insurance coverage (Anderson, 2014). This will increase their control over healthcare while also potentially increase the amount of money acquired through healthcare reimbursement.
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References
Anderson, A. (2014). The impact of the Affordable Care Act on the health care workforce. The Heritage Foundation , 2887 , 1-20.
Flanagan, M., Klein, J., Anantha, V., Muppalla, S., Karamchedu, M., Suravarapu, S., & Fraser, S. E. (2014). U.S. Patent Application No. 13/841,071 .
