Healthcare
Unit 1
Healthcare sector throughout the globe is growing at rapid dimensions and complexity with the financial environment having a significant influence in its decision making processes. The current financial environment controls proper bookkeeping and capital administration that is tasked with acquiring and utilization of resources. Its entails planning and budgeting on healthcare operations, budgetary reporting of department activities, financing, and capital investment decisions (Reiss-Brennan et al., 2016). Additionally, finance management strategies must involve long term investment decisions, finance evaluations, and the control of working capital in the various healthcare sectors.
Notably, a hospital refers to a healthcare setting which provides treatment to patients and has qualified and experienced medical personnel that attend to patients’ needs. These facilities can be differentiated according to factors such as functionality, location, size, and area of specialization. Additionally, they can be categorized as general, specialized, referral, and primary healthcare setting (Kaye et al., 2016). Each type of hospital is responsible for offering care to different people with different conditions with specific staff to handle the treatment options available.
Ambulatory care in healthcare refers to care provided to patients without being confined to hospital bed settings. Outpatient care provided involving emergency visits, consultation, and rehabilitation services with cases of minor surgery procedures (Kaye et al., 2016). The services may include performing primary care such as immunization and telemedicine services to the society where access to medical care is difficult.
Home health care setting on the other hand, refers to care provided by specialized skilled practitioners to patients in their houses and homes. The primary objective of this system is to help individuals to be self-reliant, getting better, maintaining proper body functions, and reducing the effects of body illnesses (Kaye et al., 2016). Additionally, the services may be prescribed by a doctor from a hospital as home care services may assist the individual in recovering quickly.
Long term care refers to the services offered to patients according to their needs so as to meet personal care for either short or more extended periods. These services assist an individual to live independent and safe in cases where they cannot perform some tasks on their own without assistance (Kaye et al., 2016). Furthermore, people need this care system where they have severe health disability or conditions which can develop either suddenly or gradually due to age or growing illnesses.
The integrated delivery system refers to a health mechanism where groups or affiliated parties combine efforts in delivering healthcare to the community. These parties may consist of physicians and hospital staff, such as doctors and nurses who are devoted to providing quality and proper treatment transition care to patients in the medical care system (Stanhope et al., 2016). Furthermore, this health system aims at the logical integration of care treatment to individuals as opposed to a disorganized care system.
The integrated delivery system promotes coordinated care as patients health information can be shared, leading to efficient diagnosis and treatment. The system also encourages proper disease management as the parties work together to educate the society on control and disease prevention (Stanhope et al., 2016). Additionally, medical practitioners can provide care based on the evidence, thus ensure accountability and efficient diagnosis.
Challenges attributed to implementing the integrated delivery system include technological, organizational, and cultural issues. Existing technological gaps, such as the use of apps, platforms, and systems between the stakeholders, make it hard to communicate information among the network effectively. Additionally, organizational gaps between different caregivers and levels of departments may lead to an unclear chain of command, thus prevent effective communication in the system (Stadhouders et al., 2016). The cultural differences in the beliefs and values of various departments may hinder decision making and implementations.
Unit 2
Cost classification refers to the separation of different expenses in the organization. In healthcare, the costs are classified as either, fixed cost such as employee salaries and variable costs such as diagnostic and patient supplies.
Proper cost allocation is essential in healthcare organizations as it helps to provide essential information which can be used to make decisions. Allocating expenses to different activities will help in planning, thereby efficient coordination of health activities and processes (Porter et al., 2016). Additionally, cost allocation assists to improve the provision of services to their patients, and their staff thus ensures the achievement of the set goals and objectives in healthcare.
Fee-for-service refers to payment structures where the provider gets paid for every service rendered while capitation reimbursement is where the medical provider is paid a fixed amount on the assigned people whether or not the service was delivered.
The revenue and cost structure assists in addressing various risks in healthcare from patient diagnosis to health operations. The structure assists to ensure transparency in the medical operations as the accountability of resource utilized is enhanced (Shanks, 2016). The system also improves the revenue collection cycle as the organization assesses its expenditure and collection methods. However, the structure has led to abuse of laboratory testing and consultations to raise revenue.
The finance department in the healthcare system plays a significant role in ensuring the smooth performance of the organization. The organization needs finance to negotiate contracts with its suppliers and traders to ensure an adequate supply of services. Additionally, the entity can meet its daily expenditures and perform according to the established goals and objectives (Shanks, 2016). The firm can also plan effectively and strategically hence able to meet the department activities and operations.
American healthcare uses the International classification of diseases (ICD) and Current Procedural Terminology (CPT) as the standard diagnostic classification for reimbursement and billing. ICD codes are alphanumeric characters given to each diagnosis, symptom description on causes of mortality in human beings. CPT codes are usually five-alphanumeric codes consisting of either numbers or four numbers and a letter according to the service offered (Tsopra et al., 2018). These codes identify medical, diagnostic, and surgical services that patients received during treatment. The codes are submitted with ICD codes on the claim forms to the respective payers for reimbursement to a medical provider.
Third party payers refer to entities that pay for the medical costs to healthcare providers on behalf of their clients. They include insurance companies, state and federal agencies, employers, and health maintenance organizations. These entities offer contractual agreement of health insurance to an individual with a periodical contribution to the party according to terms and conditions agreed (Berridge, 2018). The amount may be paid directly to the firm or deducted automatically from the salary of the person. Once the person receives medical care, the medical provider prepares a payment claim and submits to the third party for the assessment and processing of payment.
Methods of reimbursement used in healthcare include fee-for-service and bundled payments. Fee-for-service refers to the payment made to the provider on every service provided. On the other hand, bundled payment reimbursement consists of the payer paying the provider paid all the services rendered altogether (Tsopra et al., 2018). Coding impacts on compensation as improper coding can lead to significant harm to the patients billing process. Proper coding ensures the patient gets adequate medical care with the correct diagnosis thereby prevent endangering of patient’s life.
References
Berridge, C. (2018). Medicaid becomes the first third-party payer to cover passive remote monitoring for home care: Policy analysis. Journal of medical Internet research, 20(2), e66.
Kaye, K. S., & Dhar, S. (2016). Infection Prevention and Control in Healthcare, Part II: Epidemiology and Prevention of Infections. Infectious Disease Clinics, 30(4), xiii-xiv.
Porter, M. E., & Kaplan, R. S. (2016). How to pay for health care. Harv Bus Rev, 94(7-8), 88-98.
Reiss-Brennan, B., Brunisholz, K. D., Dredge, C., Briot, P., Grazier, K., Wilcox, A., & James, B. (2016). Association of integrated team-based care with health care quality, utilization, and cost. Jama, 316(8), 826-834.
Shanks, N. H. (Ed.). (2016). Introduction to health care management. Jones & Bartlett Publishers.
Stadhouders, N., Koolman, X., Tanke, M., Maarse, H., & Jeurissen, P. (2016). Policy options to contain healthcare costs: a review and classification. Health Policy, 120(5), 486-494.
Stanhope, V., Videka, L., Thorning, H., & McKay, M. (2015). Moving toward integrated health: An opportunity for social work. Social Work in Health Care, 54(5), 383-407.
Tsopra, R., Peckham, D., Beirne, P., Rodger, K., Callister, M., White, H., & Wyatt, J. C. (2018). The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care. International journal of medical informatics, 115, 35-42.