Healthcare reimbursement refers to the method of payment that your medical institution, dispensary, hospital, healthcare facility, or diagnostic facility uses to provide patients a medical service.
What Is Health Reimbursement?
You can Take Command Health Insurance Solutions to reap the benefits of a streamlined method of Health Reimbursement Arrangement (HRA). In a majority of cases, a government payer or a health insurer pays for the initial treatment as a part of your healthcare benefits. Some people might be responsible to make a partial payment for the initial treatment based on their health plan or health coverage. Individuals that have completely exhausted their healthcare coverage will be responsible to reimburse their healthcare provider for the cost of the initial treatment.
A health reimbursement arrangement facilitates patients to make the payment of the cost of the initial treatment already made by your healthcare provider. An HRA makes use of a third-party service that facilitates the insurance processes for the eligible employees of an organization. Medicaid and Medicare are public institutions that provide these medical facilities. In principle, the US government is the largest healthcare services provider within the country. Let’s look at the different types of HRAs you can choose from.
Healthcare Reimbursement Models
A healthcare reimbursement model is a billing system used by healthcare organizations to receive the payment of the services they provide. Each healthcare reimbursement model will have specific goals and capabilities that are unique just as their functioning.
The Fee-for-Service (FFS) is one of the most common reimbursement models. FFS takes into consideration the cost of the medical service or product prescribed by a general physician. The final bill lists all of the medical services and products including their individual prices. This is one of the most popular healthcare reimbursement models, but there is a possibility of human error while compiling the list and this is why medical institutions are trying to reduce their dependence on FFS.
Value-based care (VBC) is a broad term that includes many different payment models. The Affordable Care Act (ACA) favors this method of reimbursement because it focuses on quality rather than quantity. One of the advantages for clients is that they are no longer overcharged or incorrectly subject to inflation of prices. The patient’s overall satisfaction with the treatment provided by a certain medical practitioner is taken into consideration in the VBC model.
This is why doctors must strive to meet a higher client satisfaction rate to achieve higher performance metrics. Clients can make use of bundled payment methods that take into consideration the overall average cost of service instead of the cost of a single episode of treatment for the patient. These practices encourage transparency and accountability for the medical institutions providing medical services.
Quality Payment Methods Using MACRA
The Medicare Access & CHIP Reauthorization Act (MACRA) implements developments in the law enforced by the Centers for Medicare and Medicaid Services (CMS). These regulations integrate Merit-based Incentive Payments Systems (MIPS) with Alternative Payment Models to produce a quality payment method. Fee-for-Service and value-based care policies can be implemented at the same time in a quality payment method. This means that the patient’s satisfaction with the medical treatment is taken into consideration and payments can also be made using the fee-for-service model.