...exchanged between HIE members. This data spans across organizations within a community, or hospital system, or even whole regions. HIEs facilitate transmitting protected health information to other organizations and government agencies according to national standards. HIEs often include collaboration among physicians, home health, nursing homes, hospitals, and mental health facilities. 5 Federal Employees Health Benefits Program: The FEHB Program is for Federal employees present and retired as well as their survivors. Members have the widest selection of health plans in the country. With the ability to choose from among consumer or high deductible plans for catastrophic risk protection, health savings/reimbursable accounts and lower premiums, or fee for service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if the employee resides within the area serviced by the plan. 6 Meaningful Use: Electronic health records provide many positive factors...
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...Features of Private Payer and Consumer - Driven Health Plans Mary Davis HCR 230 September 20, 2015 Charlene Carpenter Features of Private Payer and Consumer - Driven Health Plans When it comes to health insurance plans there are many different private payers that include preferred provider organizations (PPO), health maintenance organizations (HMO), group health maintenance organizations, independent practice association (IPA), point of service (POS), Indemnity, and consumer-driven health plan (CDHP). And consumer-driven type accounts are health reimbursement accounts (HRA), and flexible savings accounts (FSA) (Valerius, Bayes, Newby, & Blochowiak, 2014). Preferred Provider Organization PPO is one of three main types of managed-care plans. It is a fee-for service plan that contracts with medical care providers who provide services for discounted fees to enrollees. If these providers have contracted with the plans they are paid more, but if they have not contracted with the plans they are covered at a lesser payment rate ("The Private Health Insurance Market", 2015). Payment of a premium and sometimes copay for visits are required for PPOs. Primary care physicians are not required to oversee patient’s care for a PPO and referrals to specialist are not required. The premium and copay for a PPO plan is much higher compared to an HMO or POS plan. There are many in-network generalists and specialists for members to choose from. Generally, higher copays, and or increased...
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...Emergency Care Group Marketing Plan April 1, 2009 TABLE OF CONTENTS 1.0 EXECUTIVE SUMMARY 3 2.0 SITUATION ANALYSIS 3 3.0 MARKET ANALYSIS 4 3.1 Market Demographics 4 3.2 Market Trends 4 3.3 Market Growth 4 4.0 COMPETITIVE ANALYSIS 4 5.0 FINANCIAL OVERVIEW 4 6.0 MARKETING PLAN 6 6.1 Marketing Objectives 6 6.2 Marketing Strategy 6 6.3 Action Plan 6 6.3.1 Products and Services 7 6.3.2 Pricing 7 6.3.3 Advertising and Promotion 7 6.3.4 Distribution 7 7.0 FINANCIAL ANALYSIS 7 8.0 CONTINGENCY PLANS 8 Difficulties and Risks 8 Worst-Case Risks 8 REFERENCES 9 Financial Appendix 10 Table 1 – Emergency Care Group Pro-Forma Income Statement 10 Table 2 - Emergency Care Group - Revenue Forecast 11 Table 3 - Emergency Care Group - Expense Forecast 11 1.0 EXECUTIVE SUMMARY 2.0 SITUATION ANALYSIS 2.1 Company Analysis 2.1.1 Strengths • Continous growth over the past seven years • Owner had experience in small rural hospitals and with staffing companies • Contracted with an extensive pool of credentialed emergency physicians • Offered value-added services such as quality assurance and education to Emergency Departments (EDs) • Four cross-functional regional teams that was composed of a recruiter, credentialer, and a scheduler 2.1.2 Weaknesses • Profits were flat during company’s growth period •...
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...meet certain standards due to the fact that they don’t have direct control. Managed care provider and hospital reimbursement ranges from fee for service and capitation. Episode-of-care is where providers receive one lump sum for all the services they provide related to a condition or disease, and capitation is where the third party payer reimburses providers a fixed amount for a period. There are many other forms of reimbursement between these two methods and vary depending on service. Risk – based payment applies to both hospitals and providers. With so many choices in health care coverage and means of payments, it becomes necessary to be sure you have a complete understanding of what is expected from you, what is covered and not covered and to be sure any treatment is necessary. Along with managed care, we have to consider how this affects Medicare and Medicaid. These have changed the healthcare system and joined together to better serve the public. Managed care; advantages and disadvantages as well as how it came to be are to follow. Managed Health Care dates as far back as 1910; one example is when the Western Clinic in Tacoma, Washington provided a wide range of medical services to lumber mill owners and employees for a monthly premium of 50cents. (Dill, 2007) Manage care pioneer, Dr. Michael Shadid, in 1929, began a cooperative health plan for rural farmers in Elk City, Oklahoma. Members who enrolled in his plan paid a predetermined fee and received medical care. In the...
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...William Geibel Week 7 assignment XCOMM/285 Tuition reimbursements can be extremely beneficial to our company because it will persuade some of our employees to continue their education and earn bachelor’s degrees in business and communication which will help our company in the long term. The more people who we can get to earn their degree will give us a wider range of people to work with and ideas to choose from. Having more people who can specialize in business and communication can also make it easier for us to be able to expand or company because we will have the people that we need to fill in the empty positions that will be created. We can also use tuition reimbursements to lure in potential employees. People could look at it as a way that they can earn a free education while they work. Improves Employee Skills If employees are able to further their education they will become more skilled. As a result, they will provide more value to the company. The knowledge and skills that employees gain from their education can translate to higher productivity and possibly more revenue and profits for the company. Employee Retention Offering a tuition reimbursement program will help a company retain good employees. Employees who have a goal to further their education will be inclined to stay with the company if it pays for their tuition. Also, many companies make it a requirement that employees stay with the company for a certain period of time after their education in...
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...What requirements would you mandate of supervisors before terminating any employee? * What are your views of affirmative action in the recruitment process? b. Manage Employee Training Process * Plan and conduct new employee orientation to foster positive attitude toward organizational objectives. QUESTIONS: * What do you believe is the most significant topic to cover in the new hires orientation? * Should cross-training within all the departments be mandated for the employees? c. Manage Performance Management Process * Analyze and modify compensation and benefits policies to establish competitive programs and ensure compliance with legal requirements. * Administer compensation, benefits and performance management systems, and safety and recreation programs QUESTIONS: * Do you believe that performance compensation should be subjective on individual merit or on group/team efforts? Or both? * What would you consider an accurate performance appraisal? d. Manage Labor Relations * Plan, direct, supervise, and coordinate work activities of subordinates and staff relating to employment, compensation, labor relations, and employee relations. * Plan, organize, direct, control or coordinate the personnel, training, or labor relations activities of an...
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...Comparison Reimbursement Programs and the Movement of Finances in the United States Health Care System by Ronald J. Sanders MBA520, MBOL2, Health Care Organization Instructor: Dr. Sandra Washington Saint Leo University Distance Learning March 17, 2013 Abstract Effective payment program strategies are a major part of administering health care. Reimbursement programs are a part of the United States (U.S) health care system. They represent a financial tool for providing cash flow to service physicians and hospitals. Many times, the ability to provide quality health care depends on the payment for the services given by physicians and hospitals. This paper presents a view of payment reimbursement systems within the health care industry. A comparative overview and description of payment reimbursement will be given in order to understand the flow of finances in the health care industry. The focus will be on the capitation and fee-for-service reimbursement systems. Readers will then be able to conclude that the appropriate reimbursement method is dependent upon the amount of risk a party is able to assume. Comparison of Reimbursement Programs and the Movement of Finances in the United States Health Care System Physicians that are part of the managed care system have several methods in which to be compensated or be reimbursed for services. Two popular methods are Capitation and Fee-for-Service. Physicians have confronted several challenges...
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...University of Phoenix Material New Hire Communication Worksheet Select a company you are familiar with. Imagine that you work for the HR department of the company. You are tasked to develop a message to orient new hires to the company culture, process, procedures, and general information. Compose a message for new hires using the three-step process outlined in Ch. 5 of Business Communication. Step 1: Prewriting Review the AIM planning process in Ch. 5 of Business Communication including the “Chapter Takeaway for Creating Effective Messages.” Analyze the situation described above by answering each of the following questions with 1 to 2 paragraphs: 1. Review the assignment directions above. What is the purpose of the message the HR employee is tasked to write? The purpose of this message is to provide a kindly welcome to new employees and anwer any general questions they might be wondering. Also to provide them with helpful information and insight about the company and it’s procedures 2. Who is the audience? What are characteristics shared by the audience that the HR employee should consider when writing the message? What do they already know? The audience is the employees or new employees who work for the company. HR should consider the audience needs, priorites, and feelings. 3. Which communication channel(s) would you choose to deliver the message and why? The best channel of communication would be email because they can...
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...Reimbursement and Pay-for-Performance Darrick Poole HCS/531: Health Care Organizations and Delivery Systems February 11, 2013 Eugene Burwell Reimbursement and Pay-for-Performance In 2010, health care expenditures in the United States almost reached $2.6 trillion. This was 10 times more than expenditures spent in 1980. The rate of increase slowed in the late 1990s and early 2000s but industry experts still expect the cost of health care to increase more than the national income for some time to come. Stakeholders agree this continual financial burden is of critical importance. During the last decade, the financial woes in the United States caused many people to lose employment and others to work for much lower wages. The effects of the financial conditions increased the focus on health care spending and peoples’ ability to afford health care. The premiums paid by employees for their families increased by 97% putting further strains on employers and their workers. Baby boomers reaching retirement age increased enrollment in Medicare and Medicaid causing strain on federal and state government budgets. In 2010, health care expenditures consisted of 17.9% of the Gross Domestic Product. Over half of the nation’s health care expenditures result from hospital care, physician, and clinical services. One way the Affordable Care Act seeks to address the issues of cost is by reducing the compensation for hospital and treatment services that result in medical errors or inadequate quality...
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...private. It will also include four observation rooms, four surgical operating rooms, a 24-hour emergency center, a maternity department including one C-section room and an intensive care unit. It will also have extensive support services such as physical therapy and cardiac rehabilitation. In order for the new facility to be a success, we must prepare next year’s financial plan and operational budget. This can be accomplished through careful planning, forecasting, and finance management. First, we need to expand the budget and take into consideration any new services being offered. We have $3 million we can use for additional staff, maintenance and other services. Funding sources The primary source of funding is through government health insurance programs. Medicare is the largest source of funding and makes up approximately 40% of the total funding for health care facilities. A second government funding opportunity is Medicaid, which is a joint responsibility of the Federal and State governments. Because of their quick reimbursement turnaround time, many hospitals rely on those reimbursements to fund the overhead costs of the facility and pay the salaries...
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...physician grew into predominately inpatient service, followed by the expansion of outpatient service. Now, the trend is starting to drift back to a more "family physician" approach with an added cost. Reduced reimbursement rates, increased paperwork, increased operating costs, and increased patient case loads have made it difficult for primary care physicians (PCPs) to be successful compared to their peers. Medicare and Medicaid reimbursement rates continue to be adjusted downward, and PCPs are expected to broaden their practices to compensate. Medical school graduates are choosing careers as specialists for an increased income, stability, set hours, and reduced case loads. As a result, the decline of PCPs has increased resulting in fewer providers coupled with a growing population. Those providers remaining in the PCP field, or deciding to enter that area of service, are looking for new ways to generate revenue and reduce the patient case load. As a result, concierge medicine, also known as boutique medicine, retainer medicine, VIP medicine, executive health program, platinum practice, personalized health care, or luxury health care, has evolved and is currently growing (Harris, 2008). Reasons for the shift in care are continued downward pressure on health plan reimbursement rates both from private insurance and Medicare/Medicaid programs, physician administrative burdens, and a demand by patients for a more responsive and personalized treatment. Concierge medicine poses a risk...
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...covers the employee by protecting and preserving his or her income if faced with the loss of employment due to no fault issues, such as cutbacks or the organization is in termination. FMLA provides up to 12 weeks of unpaid leave to employees undergoing childbirth, a recent adoption, or serious illness of his or her self; child; spouse; parents. Organization also offer voluntary benefits: paid time off, life insurance, medical insurance, health centers, retirement plans, education reimbursement, executive perks, leave of absence, and wellness plans. These accommodations are beneficial to employees based on what he or she deems necessary. Some organizations offer paid time off for employees personal, illness, or vacation needs. Life and medical insurance is offered to employees at a discounted rate and payment is taken out of his or her income monthly. Some organizations provide their employees with different facilities to help with his or her individual needs, such as health centers, places that help with retirement plans, and wellness...
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...administered funds, including those from grants and contracts. The University will reimburse the cost of authorized travel expenses incurred by members of faculty and staff and, in special cases, students or other persons, provided that: 1.2.1. the traveller was travelling on University business, or in support of the University’s mission; and 1.2.2. the traveller had advance authority to incur travel expenses (for example, through recognition of travel in a grant budget); and 1.2.3. the expenses are reasonable, appropriately documented, and comply with University policies and procedures, or the policies and procedures of a granting agency or funding contract; and 1.2.4. the expenses are approved for reimbursement by at least one administrative level higher than the person claiming reimbursement. 1.3. Travel supported by research grants or contracts must comply with University policies and procedures unless specifically indicated otherwise by the funding organization in which case the policies and procedures of the funding organization must be followed. As employees of a public institution which aims to use its resources as effectively as possible, members of faculty and staff must exercise care in...
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...Mental Health Rehabilitative Services (CMHRS) are billed under Medicaid in comparison to other industries and the impact that private and government insurers and payers have on the reimbursement process. How Medicaid is administered and funded Medicaid is a government program that is administered through the U.S. Department of Health & Human Services (HHS) in order to assist low-income people pay for part or all of their medical bills. It was created by the 1965 Social Security Act. It is federally governed but locally administered by each State. States use private health insurance companies to administer their Medicaid programs. These providers are essentially HMOs that contract with the state Medicaid department to provide services for an agreed-upon price. Other states work directly with the service providers. How to Code and Bill Medicaid for CMHRS Services In Virginia Magellan Health is the Behavioral Health Services Administrator or BHSA that the Virginia Department of Medical Assistance Services (DMAS) contracted to manage and direct Virginia’s Medicaid programs. All community mental health and rehabilitative services providers under contract with the Virginia’s Department of Medical Assistance Services must contact Magellan Health directly for information on the reimbursement and claims processing instructions. Magellan Health adjudicates claims, processes claims, and reimburses providers by the amount of units that have been billed (Magellan Health, 2015)...
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...Employees using company credit cards must provide a monthly expense report with receipts for all transactions listed on their report. Purchases over $150 require a prior authorization. All employees must complete their travel expense report within 30 days of their travel date. Travel Accident Insurance: Employees that are required to travel for business purposes are automatically covered under our company insurance plan. The company would pay for 80% and the employee would be responsible for the other 20%. Tuition Reimbursement Electrix, at management’s discretion, reimburses for related expenses for degree programs. Our feeling is that a well-rounded education, even outside of the working environment, can enhance an employee’s skill base and make them more valuable to the organization. Determination of reimbursement is based on: Criteria Degree sought (generally, there is a greater likelihood of reimbursement for bachelor’s level degrees). Potential of continued employment with the organization. Length of service with the Company (minimum of one consecutive year not on probationary status). Applicability of the degree to the job and/or future positions in the...
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