Discuss how providers are paid and why do different patients pay different amounts for the same service.
Episode payment involves paying a single price for the health care services that a patient needs for an entire care episode (Gapenski, 2011). For example, it includes all the outpatient or inpatient care that a patient requires after a heart attack. Capitation is a system of payment whereby providers receive a certain amount of money for each enrolee to offer a certain package of services that is suitable for a specific health care level within a specific period. Free-for-service is a form of payment system whereby providers are reimbursed based on the type and number of services they provide to patients.
Patients pay different amounts for the same service because health care providers charge different amounts for the same service (Gapenski, 2011). Competition is one of the factors that contribute to the price differences. While major service providers enjoy monopoly and can charge higher prices, the prices of other service providers are widely determined by competition in a particular area. Under tiered-service, patients are charged according to the level of the service they receive.
Discuss What a Third Party System Is
In the third party system, an organization or a person ancillary to the patient-doctor dyad finances the health care services rendered by a provider (Ward, 2011). In the U.S., the third party, payment system involves a health insurance entity that makes payments to providers on behalf of the insured.
Discuss Why Some Charges Aren't Reported As Revenue for Healthcare Organizations
Some charges are not reported as revenue for healthcare organizations because they are lost charges that include procedures, supplies, or services that were administered or provided during a patient’s visit yet they were not entered into the E.H.R or marked into charge slips. Inaccurate marking of service items implies that it will be difficult to bill the charges; therefore, such services are not billed.
Discuss Government Regulations
Health care regulation in U.S. is a complex system that involves various actors, entities, agencies, organizations, both private and governmental, that form part of the regulatory process. The Department of Health and Human Services houses most of the agencies that are involved in the regulation of America’s healthcare system (Ward, 2011).
References
Gapenski, C. (2011). Healthcare Finance: An Introduction to Accounting and Financial Management. Oxford: Oxford University Press.
Ward, M. (2011). Accounting Fundamentals for Health Care Management. New York: McGraw Hill Press.
