Dear Dr. Stephen Strange: You recently requested pricing information from our company. Here is our Medical Billing Services Rates: Our medical billing services fees is based on a percentage of the amount you receive, both from insurance and patients. The only other charge is a one-time startup fee. This is $300.00 per clinician, with a maximum charge of $2,000.00 for 7 or more clinicians. We have two types of pricing: our Standard Pricing Plan and our Individualized Pricing Plan. Many of our customers meet the criteria for our Standard plan, and if you do, your rate will be between 5% and 7% of the amount you receive. Other customers have specialized needs or claims that may pay a larger or smaller amount. The rates for our Individualized Plans
On the basis of the clinic’s previous collections experience, Dough was able to convert billings for medical services into actual cash collections. On average, about 20% of the clinic’s patients pay immediately for services rendered. Third-party payers pay the remaining claims, with 20% of the payments made within 30 days and the 60% remainder (of total billings) paid within 60 days. For monthly budgeting purposes, 20% are assumed to be collected one month after the billing month, and 60% are assumed to be collected two months after the billing month.
Chapter 6 describes revenue determination. Write a 3-4 page paper to include: List and discuss the three payment-determination bases. Explain the difference between a “specific services” payment unit compared to a “bundled services” payment unit. Describe the three major ways that health care providers can control their revenue function. I expect at least 5 secondary sources properly cited and referenced for this paper.
Those patients who have health insurance are expected to pay their co-payment immediately upon checking in. You are required to have an insurance card and know your co-payment ahead of time. Typically speaking, co-payments for urgent care range between $35 and $100 per visit. You will have to check to make sure your insurance is accepted at your local urgent care center.
This module of study has focused on many aspects of human health, anatomy, and the disease process. It has included such topics as the human organ systems, the mechanism of disease and the resulting disruption of homeostasis, the integumentary system, and the musculoskeletal system. The following case studies explore how burn classification will affect treatment, how joint injuries can disrupt mobility, and last, how a sedentary lifestyle can contribute to a decline in a person’s health status. The importance of understanding disease and knowing when to seek treatment is the first step toward enjoying a balanced and healthy life.
In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. This drives up costs by rewarding providers for doing more, even when it’s not needed. ACOs continue to utilize fee for service by creating incentives to be more efficient by offering bonuses when providers keep ...
Meet with mother of this particular patient. The mother is a Caucasian disable Veteran. Mother is concerned because she can no longer afford to utilize the General Academic Pediatric Clinic (GAP) services because currently the children does not have health insurance coverage. Mother reported that Veteran Affairs does not provide health insurance coverage for her children because of an eligibly level ranking system. She reported, previously, she paid for services through making a payment arrangement in which was out-of-pocket. However, today she was informed of accountancy services that going forward all clinic visits must be paid in full as a result of a previous 3,000 balance. Mom indicated, she cannot afford to pay for visits in full. She
Fordney, M. (2010). Insurance handbook for the medical office. (11th ed.). Maryland Heights, MO: Saunders Elsevier.
Patient number 1 has a normal ABG except for the PaO2, which is 229. The FIO2 is way too high and should be decreased.” Although supplemental oxygen is valuable in many clinical situations, excessive or inappropriate supplemental oxygen can be deleterious”(Sawatzsky, D. 2016). The question is how far should the FIO2 be decreased. I would titrate the FIO2 down by ten every hour, and watch the patients pulse oximetry to ensure the patient does not desaturate.
In order for any health care system to be stable in their revenue cycle, it has to post charges for procedures and care provided. If these charges are not posted correctly, the payments may be affected, resulting in less income than what the system is actually owed. Clearly, without any service being provided, there is no revenue to begin with, but if the charges are not captured, a service can be provided and not billed for (Cleverley & Cameron 2007). This means the health care system provided free care or services to a patient. In order to capture care charges, health care organizations use codes for each type of procedure provided. Because the health care industry is so complex, capturing said charges is also complex and most charges are broken down in order to prevent complex bills. The way charges are broken down is by using codes for the services rendered. Each procedure has a special code and each code is assigned a price, making billing less complicated. Coding also allows health care systems to document each procedure in order to prevent payment denials or delays from the payer (Thompson & Barrett 1993).
Miller, J. (2013). Payers rethink utilization costs. Managed Healthcare Executive, 23(11), 9-9,15. Retrieved from http://search.proquest.com/docview/1458614037?accountid=36202
Problem Statement: Should Dr. Roger Mahon, Pate Memorial Hospital (PMH) administrator, take action, if any, to compete with the newly established clinic, located five blocks north of PMH’s clinic?
This would be a bundled care coordination fee, and it would be rather risk-adjusted, and it would also be very much reflective of the capability of practices services, and it will be based on the set model of PCMH Health and medicine (Harvard University reports findings in internal medicine, 2016). The other aspects would be the visit free based fee for the service component, and this component is to recognize the visit based services that are under the current payment of a fee for service payment and which maintains an incentive so as to enable the physician to see the patient in the office whenever it is deemed appropriate. This payment model also contains a performance-based component and there, it more of recognizes the achievement of quality and efficiency
You may charge $100 for the annual physical and $30 for the bloodwork. That information should be clear to the patient.
The chargemaster is an integral element of the revenue cycle. It is used in generating charges for services that are rendered to patients in real time, the absence of functioning chargemaster can result in potential collapse of the revenue cycle. Hence, the process to optimize revenue cycle must include optimizing the chargemaster and all services that is associated with it. The negative consequences of nonfunctioning chargemaster can include excessive payment/overcharging, inaccurate billing to patients; and can result in stiff penalties and fines (Bielby et al,
The price you pay for the same procedure, at the same hospital, may vary enormously depending on what kind of health insurance you have in the US. That's because of bargaining power. He talks about how government programs, like Medicare and Medicaid, can ask for a lower price from health service providers because they have the numbers: the hospital has to comply or else risk losing the business of millions of Americans. Greene also mentions that there are dozens of private health insurance providers in the United States and they each need to bargain for prices with hospitals and doctors. The numbers of people private insurances represent are much less than the government programs. That means a higher price when you go to the doctor or fill a prescription. Uninsured individuals have the least bargaining power. Without any insurance, you will pay the highest price. Lastly, John discusses the complicated reasons why the United States spends so much more on health care than any other country in the world, and along the way reveals some surprising information, including that Americans spend more of their tax dollars on public health care than