Topic > Healthcare Cost and Revenue Management - 2273

With this type of organizations have different payment methods and reimbursements. They have guidelines through the government that they will have to comply with. Government-sponsored payers are Medicaid and Medicare. Most patients treated are covered by Medicare or Medicaid. With uninsured patients, each type of organization handles reimbursement differently. In for-profit hospitals, this is called bad debt, which is when patient bills are written off. With non-profit organizations it is considered charitable assistance. This type of care must be documented and reported on your tax status. Private insurers are patient with other insurances. With Medicare and Medicaid, services provided by hospitals are paid for through prospective reimbursement. Any refund is established before the provision of the services. They have a defined dollar amount per day and per diagnosis. They also use a fee set by the CPT code or procedure code that is usually used for doctors. Since only these insured patients are billed a certain amount, most procedures are not fully reimbursed. Retroactive reimbursement is determined after services have been provided. This is one of the reasons why organizations are struggling. In addition to the lower reimbursement, CPT codes or procedure codes must be corrected according to the procedure ordered. “If an organization wants to get paid, it is best to take the time to ensure that all its codes are accurate, timely, and meet all payer requirements” (Kapsambelis, 2004, p. 3). When good claims go bad, " beneficiaries who are not covered; services that taxpayers deem not reasonable and necessary; services provided that were not covered; duplicate bills... half the paper... to succeed they must keep up with the new technology. Works Cited Bigalke, JT (2009, February). ). Cost and Revenue Management. (ed.), Introduction to healthcare management (ed. pp. -). of GDP by 2035 [Healthcare Financial Management Association]. (2010, August, 9. Excerpt from the Journal of Healthcare Finance (2008). scope. Journal of Healthcare Finance, 63-75.Kapsambelis, N. (2004, October). Getting Paid in Behavioral Health Care [Team Spirit]. , 9(10), 1-4. Extracted from