The healthcare system in the United States has adopted a complex and elaborate system for payment. Through this system, employers, the government and private insurers join forces to cover the cost of medical services. To ensure that payments are made smoothly and in good time, various reimbursement methodologies are available. These methodologies allow medical facilities to make claims which and then processed before payment is released (Richards, 2009). The different reimbursement methodologies possess unique features which make them ideal for different situations. However, despite their differences, these methodologies present challenges and possess flaws which hamper the effective delivery of healthcare. Quantum Healthcare is among the thousands of healthcare providers that have benefited immensely from the reimbursement methodologies. If this institution is to witness improvements in service delivery, it needs to integrate best practices into its reimbursement programs.
Quantum Healthcare
Quantum Healthcare is an institution that offers primary care. The institution has established a presence in a number of states where it has set up facilities. The organization attends to the medical needs of hundreds of Americans every year. The success that this organization continues to enjoy is the result of the adoption of a number of innovative approaches. Thanks to these approaches, Quantum Healthcare has been able to significantly reduce the cost of care while improving patient outcomes. Since it operates in the US, this institution is required to adhere to guidelines and laws. For example, the Health Insurance Portability and Accountability Act (HIPAA) introduced new provisions that are intended to enhance patient wellbeing. The need to safeguard patient privacy is among these provisions. In all their operations, medical facilities should accord their patients utmost privacy and ensure the confidentiality of all the information that the patients share. Quantum Healthcare strives to fulfill the requirements that such laws as the HIPAA stipulate. In recent years, this institution has encountered challenges that threaten to erode the progress that it has made. In the discussion below, focus is given to the reimbursement methodologies that Quantum Healthcare uses. This discussion seeks to shed light on the flaws and shortcomings that must be addressed if the institution’s future is to be secured.
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Reimbursement methodologies and processes at Quantum Healthcare
As made clear in the discussion above, Quantum Healthcare has adopted a number of methodologies and processes for reimbursement processes. The process that the institution has adopted is comprised of five important steps. This process begins when the institution submits a request for reimbursement. The request is submitted to the party with the mandate of covering the cost of payment. Employers and Medicare are the primary parties that the facility appeals to for reimbursement. Quantum Healthcare is not alone in its relationship with employers and government agencies charged with handling medical insurance. Most healthcare providers which treat patients with medical insurance rely on reimbursements from employer insurance schemes and such federal programs as Medicaid. In addition to the government and employers, Quantum Healthcare also works with private insurance companies. Today, these companies are among the biggest players in health insurance in the United States. According to figures that the Centers for Disease Control and Prevention shared, private insurance companies offer coverage to 65% of those who are at least 65 years old. These companies offer medical insurance to 53.8% of children and 69.2% of the individuals in the 18-64 age group (CDC, 2017). These figures are clear evidence that private insurers are the biggest sources of reimbursement.
Processing and adjudication are the second and third steps in the reimbursement process that Quantum Healthcare has adopted. Processing involves the insurance provider receiving the claim that that institution has submitted. At the adjudication stage, the insurance provider scrutinizes the claim to ensure credibility and accuracy. It is at this stage that the insurance provider establishes that the details that Quantum Healthcare has provided are in line with the information that the insurance provider has regarding the status of insured patients. For example, the insurance provider confirms that the claim reflects the type of insurance coverage that the patient signed up for.
The steps described above are indeed vital aspects of the reimbursement system that Quantum Healthcare has developed. After these steps, the insurance provider makes payment for the services that are offered. The provider also sends an explanation of benefits (EOB) to the patient. The EOB offers an overview of the medical services that the provider has paid for. It is a document that ensures accountability and provides the patient with guarantees that payment has been made for medical services offered. There have been numerous instances where Quantum Healthcare contests the payments that the insurance providers have made. This usually occurs when the payment is lower than the amount that Quantum Healthcare expected. The fifth and last stage of the reimbursement process accommodates such situations. At this stage, Quantum Healthcare conducts reconciliation. Reconciliation is concerned with analyzing the payment received and comparing it to the amount request in the reimbursement claim. There is a separate process that Quantum Healthcare uses to handle disputes and to carry out reconciliation.
The discussion above has offered a general overview of the reimbursement methodology that Quantum Healthcare uses. For an even deeper understanding of the institution’s reimbursement procedure to be gained, it is helpful to examine specific elements of the procedure. Coding and billing are among the elements that require closer scrutiny. In the US, healthcare institutions use a variety of coding standards for the purpose of seeking reimbursement. These standards include Current Procedural Terminology (CPT), Clinical Modification Diagnosis and Procedure Codes (ICD-9-CM) and the Healthcare Common Procedure Coding System (HCPCS) (“Introduction to Billing”, n.d). The different coding systems allow for the standardization of the billing process. To ensure uniformity and consistency, Quantum Healthcare requires all its practitioners to refer to the CPT. Essentially, the CPT identifies a wide range of services that practitioners and facilities usually deliver (“Introduction to Billing”, n.d). This standard is recognized as a credible and authoritative source of information on proper billing procedures. Hundreds of facilities and health insurance providers in the United States use the CPT. Quantum Healthcare must be commended for the wisdom that it has displayed in opting for the CPT as its standard for coding.
As pointed out above, the CPT is not the only coding standard available. Quantum Healthcare’s decision to opt for this standard is deliberate and founded on sound logic. Such standards as the ICD10 possess limitations that render them unsuitable for certain medical conditions and situations. For instance, in their discussion on the ICD10, Izeta Kurbasic and fellow scholars note that “this classification is not suitable in cases where few or no information about patient is available” (Kurbasic, 2008, p. 161). In its decision to adopt the CPT standard, Quantum Healthcare must have considered the limitations of other alternatives. The institution’s decision to opt for the CPT should inspire other medical providers to select the coding standard to use carefully.
Roles of key stakeholders
The reimbursement methodologies that Quantum Healthcare uses are rather complex. These methodologies call for the involvement of various stakeholders who perform different roles. The coding specialist is one of these stakeholders. As the title suggests, this specialist is involved in coding. Essentially, the specialist needs to ensure that the charges for medical services are in line with the guidelines in the coding system that Quantum Healthcare uses. The coding specialist also engages in conversations with insurance providers. These conversations are for the purpose of facilitating payment for services delivered. Physicians, nurses and pharmacists are other stakeholders who are involved in the reimbursement process at Quantum Healthcare. The role of these stakeholders is rather limited. They are simply required to forward details of diagnoses, treatments and medications provided to patients to the coding specialist. The specialist then works with these details to determine the reimbursement amounts. Private insurance providers and government agencies that administer such insurance schemes as Medicaid are also stakeholders in the reimbursement process. These stakeholders receive and process claims from Quantum Healthcare. Overall, this facility has established an elaborate system that brings together different stakeholders.
The stakeholders identified above are required to adhere to strict reimbursement policies and procedures. The procedures are as outlined in the discussion above. They begin with coding and conclude when payment is received. Some of the policies that Quantum Healthcare has adopted include the need for accuracy and honesty. The facility requires its practitioners to confirm that the details they forward to the coding specialist are accurate. Moreover, Quantum Healthcare demands that all its practitioners must be honest as regards reimbursement. Another policy that the facility has adopted concerns collaboration. The various practitioners are expected to work together to ensure that the reimbursement process runs smoothly.
Evolution of reimbursement within HIIM
Medical practice is fluid and dynamic. Instead of being static, it responds to the changes that occur in the environments where medical practitioners function. Reimbursement is among the processes in medical practice that have undergone evolution. One of the forces that has fueled the evolution of reimbursement is the shift from one payment system to another. In previous years, practitioners and facilities bore no risk (Lerman, n.d). During this period, they used retrospective reimbursement methodologies such as fee-for service. These methodologies favored the medical providers as they shielded the providers against risk. Using these methodologies, the providers were assured of receiving payment for all services delivered (Lerman, n.d). The adoption of prospective payment methods introduced changes. These methods include capitation. As opposed to the retrospective methods, the prospective processes challenged medical providers to share in the risk of delivering care (Lerman, n.d). The evolution from retrospective to prospective reimbursement methods is clearly a step forward as it enabled medical facilities to take on greater risk.
The adoption of laws and guidelines which govern coding and billing is yet another development that has facilitated the evolution of reimbursement processes. The US has enacted laws which cover a wide range of issues that concern reimbursement. For example, there are laws that require medical facilities to provide sufficient documentation, deliver services that are medically necessary and to avoid inaccuracies when recording diagnoses and coding (“Regulations that Affect”, 2015). There are also legal provisions that seek to tackle fraud and abuse. The US government has adopted the Fraud Prevention System. This initiative is aimed at addressing such issues as improper payments (“Regulations that Affect”, 2015). The laws that the US has enacted also seek to promote patient wellbeing while reducing the rates of patient readmission (“Regulations that Affect”, 2015). Overall, the legal landscape in the US has played a critical role in facilitating the growth of reimbursement processes. Instead of being mainly concerned with ensuring that medical facilities receive payment, these processes also safeguard the wellbeing of patients.
Influence on Quantum Healthcare
The reimbursement methodologies that Quantum Healthcare has adopted have had far-reaching impacts. Facilitating payment is among these impacts. Through the different reimbursement processes, the practitioners at Quantum Healthcare are assured of payment for all the services that they have rendered. Another impact of the processes is that they have encouraged illegal and unethical behaviors. In the discussion that follows, it will be revealed that Quantum Healthcare has received reports of some of its practitioners engaging in fraud. Fraudulent behavior is the result of the flaws and loopholes in the reimbursement processes that the facility uses. These flaws make it possible for the practitioners to overcharge for services and to deliver services that are unnecessary. Enabling Quantum Healthcare to finance its operations is yet another effect of the reimbursement processes. The processes allow the facility to receive funding. The funding is then used to finance operations. Overall, while the reimbursement processes have exposed Quantum Healthcare to such ills as practitioner fraud, the processes are a key driver of the facility’s operations as they allow for funds to be received.
Challenges
The reimbursement methodologies that Quantum Healthcare uses have enabled it to continue to deliver care to thousands of patients across the numerous facilities that it operates. However, there are a number of challenges that the institution faces. These challenges have made it remarkably difficult for the institution to ensure accountability and to deliver quality care. In the discussion that follows, some of these challenges are explored in detail.
Most Americans rely on government agencies and private insurance providers for medical coverage. However, there are a small number of Americans who work with exclusive provider organizations. Basically, these organizations are medical facilities which are part of a network that brings together various institutions which are the exclusive providers of care (Green, 2017). Some of the practitioners who work at Quantum Healthcare belong to networks of exclusive provider organizations. These practitioners only receive reimbursement if they attend to patients who are under managed care plans. While the networks limit the freedom of the practitioners, they provide guarantees of reimbursement for all the covered services that the practitioners render.
Greed and fraud among practitioners
Integrity is one of the fundamental pillars of medical practice. Practitioners are expected to demonstrate the highest levels of honesty and faithfulness. A majority of medical practitioners understand the vital role that integrity and honesty plays in securing the image of the profession. However, there is a small minority of practitioners who disregard the ethical guidelines that require members of the medical profession to conduct themselves in a fashion that brings honor to the profession. These practitioners are greedy and are involved in fraudulent activities (Fabrikant et al., 2017). They exploit reimbursement processes to enrich themselves at the expense of patient welfare and the financial security of medical institutions. Health fraud is among the most serious threats to the delivery of medical services in the United States. In an interesting piece, Charles Piper identified some of the most common fraudulent activities that greedy professionals engage in. These activities include charging patients and insurance providers for services that were never delivered and billing services that are not covered under insurance policies as though they are covered (Piper, 2013). Other activities include providing false dates and locations of service. To honor claims for reimbursement, insurance providers usually require that the claims must be submitted within a certain number of days after service has been delivered. When they realize that the number of days has lapsed, some practitioners indicate wrong dates in the claim forms.
Quantum Healthcare has observed with some concern that some of its practitioners are involved in various forms of health fraud. This facility has noted that there are some practitioners who falsify documents while others bill for services that have not been rendered. Moreover, some of the practitioners collude with patients to defraud insurance companies. The behaviors of these practitioners fly in the face of ethical guidelines and the Hippocratic Oath that medical practitioners are expected to honor. The oath challenges practitioners to strive to safeguard the health and overall wellbeing of their patients and shun away from activities that could cause harm (Miles, 2005). It is evident that the fraudulent activities go against the oath. Quantum Healthcare has already initiated some measures in a bid to rein in on fraudulent practitioners. For instance, this facility has issued warnings and circulated a code of ethics and conduct that all the practitioners are required to honor. However, these measures have had very limited success. Fraud continues to pose a real threat to the mission and operations of Quantum Healthcare.
Use of paper
Electronic health records management is one of the trends that are shaping healthcare delivery today. An increasing number of healthcare providers are recognizing the many benefits that electronic records management presents. For example, healthcare providers that have adopted electronic systems incur lower costs and achieve higher levels of efficiency (Hillestad et al., 2005). Additionally, these health management systems enable medical service providers to accord patient information greater security. Another benefit that the systems offer is that they allow medical facilities to minimize errors during the coding and billing process while seeking reimbursement for services delivered (Leventhal, 2013). Quantum Healthcare is among the organizations that are yet to fully embrace modern technology and electronic health records management. Currently, the institution still requires its practitioners to use paper to record the ailments for which patients have received treatment. The paper-based system that the organization uses presents a number of challenges. One, this system is responsible for the many errors that the practitioners make. When the practitioners submit claim applications that contain errors, the insurance providers refuse to process the claims and ask the practitioners to submit new applications. The errors are responsible for time delays as the facility has to wait longer to receive payment. Two, the paper-based system has seen practitioners lose critical patient information. For example, recently, one of the employees in the records management misplaced important files. Having failed to locate the files, Quantum Healthcare was forced to forego the payment that it was owed for dozens of services that it had delivered. Three, the paper-based system is not cost-effective. Quantum Healthcare incurs thousands of dollars in such endeavors as purchasing stationery. When it abandons the paper-based system, the facility stands to enjoy a number of gains.
Best practice recommendations
The discussion above has revealed that there are a number of challenges that hamper the effectiveness of the reimbursement methodologies that Quantum Healthcare has adopted. To address these challenges, the institution needs to adopt best practices that have been established to be effective in enhancing reimbursement processes. The following discussion explores a number of these practices and challenges Quantum Healthcare to integrate the practices into its culture and operations.
Quality care models
Health fraud has been identified as among the problems that hinder the effectiveness of Quantum Healthcare. This problem has harmed patients and damaged the image of the institution. The Affordable Care Organization (ACO) model is among the best practices that the institution can adopt to tackle health fraud. Basically, the ACO model brings together practitioners who attend to Medicaid patients. The model rewards these practitioners for delivering quality care (Fendrick et al., 2009). The ACO model promises to address health fraud as it will remind the practitioner at Quantum Healthcare that their primary focus should be the wellbeing of patients instead of their own welfare. The benefits that the ACO model will offer go beyond tackling health fraud. This model has also been shown to enhance patient outcomes (Fendrick et al., 2009). As it integrates this model into its operations, Quantum Healthcare will be joining the dozens of providers who are able to deliver improved care to their patients.
Technology and informatics
It has been stated in an earlier section that Quantum Healthcare still uses a paper-based system for reimbursement purposes. This system is outdated and inefficient. The adoption of modern technology, informatics and electronic health records management will revolutionize the facility’s operations. Various scholars have established that modern technologies and techniques present a wider range of benefits. For example, Jennifer King and other scholars established that electronic systems deliver clinical benefits. These systems particularly enhance patient communication while allowing practitioners to deliver appropriate care (King et al., 2014). The benefits of electronic systems go beyond improving clinical outcomes. After examining the impacts of electronic systems on healthcare delivery, Matthew Manary and his colleagues observed that the systems facilitate reimbursement (Manary, 2015). Since it has been proven that electronic health record systems enhance reimbursement processes, Quantum Healthcare has no reason to continue to hold on to the outdated paper-based system. Abandoning this system will see the institution report less errors while improving patient outcomes and the security of patient information.
Stricter ethical guidelines
The best practices recommended above involve overhauling the systems and processes at Quantum Healthcare. The huge costs that the institution is likely to incur will undoubtedly discourage the adoption of the best practices. There are other effective approaches that are more cost-effective and easier to integrate into practice. To address the problem of health fraud, Quantum Healthcare needs to adopt a culture that focuses on ethical conduct. The institution needs to introduce stricter ethical guidelines. Moreover, the institution should make it clear that any practitioner who engages in fraudulent activities or violates the ethical guidelines will face harsh punitive action. Ethical guidelines and codes of conduct are effective tools for promoting value-based practice (Loughlin, 2014). The ethical guidelines will challenge the practitioners at Quantum Healthcare to channel all their energies towards delivering quality care.
Impact on medical profession
Health informatics and information management is a key element of healthcare delivery. As pointed out above, data analytics can enable medical institutions to improve their reimbursement processes. Reimbursement is also relevant to the medical profession. It has already been stated that reimbursement allows medical practitioners to receive payment for the services that they offer. The role that reimbursement plays in the compensation of practitioners points to the relevance of reimbursement to the medical profession. The damage that such ills as fraud and greed cause is another issue that makes reimbursement relevant to the medical profession. It was observed that some practitioners who work at Quantum Healthcare engage in fraudulent activities. The behavior of these practitioners has damaged the reputation of the facility while eroding patient trust. Through an exploration of reimbursement methodologies, one is able to understand why it is important for practitioners to embrace such values as integrity and honesty. As they adopt these values, they will restore faith in the medical profession.
Thanks to the discussion above, it is evident that the issue of reimbursement has impacts on the medical profession. Investigating how reimbursement shapes the operations of Quantum Healthcare has also enhanced my skills and expanded my perspectives. Before beginning the project, I did not fully understand how reimbursement affects the operations of medical facilities. Now, I recognize that the reimbursement methodologies that a facility adopts influence its operations to a significant extent. Some of the skills that I have acquired through this assignment include research and information synthesis. I believe that this project also opens up career opportunities. I am confident that I am now able to serve in any position that involves improving reimbursement processes. Investigating how reimbursement methodologies shape Quantum Healthcare’s operations calls for one to possess certain education requirements. Familiarity with the processes applied in medical settings and an understanding of medical insurance in the United States are among these requirements. These requirements provide individuals with the background information they need to properly investigate Quantum Healthcare and its reimbursement methodologies.
The issue of reimbursement methodologies presents implications for health informatics and information management. Data analytics is a critical component of effective reimbursement methodologies. This is why Quantum Healthcare has been advised to embrace data analytics. Data analytics is also closely related to HIIM. Thanks to data analytics, firms are able to obtain insights from raw information. Essentially, data analytics facilitates decision making and process improvement. HIIM also aims to provide organizations with insights and perspectives for process improvement. Therefore, data analytics allows for the general objectives of HIIM to be achieved.
This project has highlighted the role that reimbursement plays in HIIM. The project has also revealed that there are various educational requirements that one must possess if they are to effectively explore reimbursement methodologies. Familiarity with various concepts has been identified as among these requirements. Another educational requirement is critical thinking. Education challenges individuals to dig deeper and think critically. Critical thinking is essential as it allows one to fully understand the wider impacts and implications of reimbursement.
The impacts of this project go beyond shedding light on the educational requirements that are needed. It also highlights various career opportunities that one may pursue. With the information gained through the project, one is able to work in a variety of healthcare settings. For example, one could serve as a coding specialist. While the information contained in the project is not sufficient or extensive, it covers the basic elements of medical insurance. Essentially, the project provides one with the basic knowledge needed to pursue medical coding. Another career that the project has opened up is in information management. One could serve as a medical information specialist who uses patient records to identify improvements that can be made to enhance patient wellbeing.
Research methodology used
Consultation of literature is the main research method that was used. Various works of different scholars were examined for insight on various aspects of reimbursement. These works explore such issues as the reimbursement methodologies that medical facilities use and the challenges that these facilities encounter. The best practices that medical institutions can adopt to improve reimbursement and healthcare delivery are other issues that the works addressed. Apart from a review of literature, the project also involved interviews with healthcare professionals. Thanks to these interviews, insights into the impact that greed and fraud have on healthcare delivery was gained. Combined with the literature review, the interviews allowed for an in-depth understanding of reimbursement methodologies.
Areas for further research
The scholarly community has committed remarkable effort to research reimbursement methodologies. Their effort has shed light on various methodologies and their effect on the delivery of medical services. However, there are some areas that require further research. One of the gaps that provide an opportunity for further research is the impact of the ACOs model on reimbursement and healthcare delivery. The adoption of the ACOs model is a fairly recent development. As has been observed above, this model has delivered a number of benefits. It will be interesting to determine if these benefits are sustainable or this model only delivers the benefits for the first few years after its adoption. Researchers should therefore continue to examine the impacts that this model has on medical facilities. Another issue that requires further research is the relative value of the adoption of informatics and information technology. It has been recommended that Quantum Healthcare should adopt these tools so as to improve care and address the challenges that it faces. The facility should implement this recommendation with caution. The fact that informatics and information technology could present such challenges as privacy concerns necessitates the need for caution. To guide the adoption of these measures, researchers need to investigate whether the privacy concerns are grave enough to convince Quantum Healthcare to drop informatics and information technology.
Conclusion
Quantum Healthcare continues to offer vital services to thousands of patients every day. A robust reimbursement process is among the forces that drive the institution’s operations. The organization uses an elaborate process to apply for reimbursement from government agencies and insurance providers. The process begins with submitting an application and concludes when Quantum Healthcare has received payment and reconciles the payment. Despite its dedication and efforts to safeguard the wellbeing of its patients, Quantum Healthcare grapples with such hurdles as health fraud and the inefficiencies of its paper-based record management system. These hurdles make it difficult for the facility to receive payment from insurers. If it is to addresses these challenges and improve the delivery of care, Quantum Healthcare needs to adopt the best practices that have been recommended above.
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