Medical Care Reimbursement, Capstone Project Example

Introduction

Medical-care reimbursement is a program, which compensates hospitals and physicians for the provision of health care to qualifying individuals who cannot finance their own medical expenses. With structural changes in the economic and social sectors, health care aspects revolutionize. The price of healthcare and medical care changes with new aspects of technological advancements. This makes the price of healthcare expensive. Being ill is now an additional expense with the high prices in prescriptions and monthly premiums. The central enduring financial challenge that the nation is facing is the rising costs in Medicare, Medicaid, and other centralized health-related programs. The government sets measures that examine the rising costs within a centralized health program, in addition to, achievable policy responses.

Background Information

The main tasks the network forensics team carries out fall in three main categories. Before the Medicare, system refurbished its reimbursement policy to the current Medicare Fee Schedule, reimbursement for physician services based on the Customary, Prevailing, and Reasonable system. This system determined reimbursement. It carried out selection of lower options. First, it determines the actual charge physicians make. It also determines the physician’s customary charge for the services they offer. Lastly, it also looks at the prevailing charges updated by the Medicare Economic index.

Objectives of the Project

The main objective of provision of medicare reimbursement is to control the costs of healthcare. This is done through the provision of incentives to hospitals promote liberation of a cost-effective health care to patients.

Purpose and Scope of the Project

This project is a thorough research medicare reimbursement. It examines the effects of medicare reimbursement. It also looks at the affected groups, and the negative consequences of laying cuts on medicare reimbursement basing on the level of occurrence.

Impact of Medicare Reimbursement

We find a significant, positive relationship between Medicare’s payment rate and the quality of health care given in hospitals. In some cases, the effects are minute. For hospitals with average characteristics, the effect of payment on quality is insignificant. However, for hospitals that are exceptionally paid highly for exchange of health services and those that treat large numbers of patients with different ailments, there is a positive and significant relationship. For such hospitals, which likely derive considerable revenue from health care, an increase in Medicare’s payment for patient admissions leads to a small and significant improvement in the quality of patient care provided.

Negative Consequences of Medicare Reimbursement

Legislative actions on medicare cut progresses. The groups that are mostly affected by these legislative cuts influence legislative fixes. This measure aims at increasing revenue and reducing program spending. The result is that the funds for medicare exceed allocated funds making it difficult for the program to obtain funds from other sources, as there is close monitoring.

The government may also limit the growth of medicare programs. The total expenditure on reimbursement exceeds the target. The growing size of medicare threatens funds meant for other programs. It is due to this that the government imposes intensives to keep the expenditure within manageable boundaries. The cuts imposed cause harm and thus the government should implement responsible controls to mitigate harm while carrying out reforms.

Politics also affects policies on reimbursement. Politics favors the interest of populations, groups, and political parties. Politicians win or lose depending on how these measures unfold.

Medicare recipients are also affected. Advancements in technology make patients have a wide range of procedures, pharmaceuticals, and services at their disposal. Reimbursements cuts act as a barrier to obtaining health care. Lower reimbursements make the providers to be reluctant in receiving new medicare patients.

Physicians and hospitals also stand at risk. Changes in patterns of medical practice and escalating health costs affect physicians. This in-turn affects many physician practices and hospitals. The benefit they obtain later comes from moderation of program growth and programs remaining solvent.

Conclusion

Reduction of medical-care reimbursement is a vital issue. The government needs to set time in generating sustainable strategies. There is also advance need to balance long-term objectives with the immediate effect of cuts. The decisions made ought to be difficult and calculated on the efforts to reduce healthcare spending. Current expenditures on medical-care source from maintaining chronic conditions.

References

Majdi, C.(2009). “Medicare Reimbursement Cuts – A Policy Perspective.” Web 19 July 2011

http://www.medicareadvantagesupplementplans.com/medicare-reimbursement-cuts-a-policy-perspective/

“What Is the Purpose of Medicare’s PPS?” Web 19 July 2011

http://www.ehow.com/facts_7322480_purpose-medicare_s-pps_.html#ixzz1SYkughJd

Amporfu, E. (2004). “Health  Economics” St. Francis Xavier University. Web 19 July 2011

http://ir.lib.sfu.ca/retrieve/2340/etd1931.pdf