Discussion Response: Getting Started and Reimbursement InefficienciesReading and ResourcesLecture 1.1: Healthcare Finance and the Revenue Cyclehttp://snhu-media.snhu.edu/files/course_repository/undergraduate/hcm/hcm345/module_one.pdfTextbook: Health Care Finance and the Mechanics of Insurance and Reimbursement, Chapters 1 and 10Library Article: Effective Hospital Revenue Cycle Management: Is There a Trade-Off Between the Amount of Patient Revenue and the Speed of Revenue Collection?PDF: HFMA Revenue CyclePeer response:In response to your peers, support the points they made around what seems to be working and what needs improvements with one additional idea.Classmate #1:Deborah Annese posted Feb 28, 2021 3:48 PMMy name is Debbie, and my educational background is in Dentistry. I worked in private practice for 20 years. I have since started teaching dental hygiene students in the clinical setting at a local University, I have never been happier and love what I do. As far as my experience with healthcare reimbursement, I have seen the professional side of reimbursement in the dental office, I refer to dental plans as discount plans because the insurance companies don’t pay for a lot of dental services. I have however experienced the patient side of hospital reimbursement. Over the past few year’s my healthcare coverage has seen a drastic change, I have had really good insurance that covered 80% or more of out-of-pocket fees, now I have the bare minimum coverage due to costs. I am currently making payments to my local hospital for services rendered last year and to be quite honest if I wasn’t given that as an option, I would have had to mortgage my home. Since the Affordable Cares Act has been in place, my insurance has never been the same. The out of pockets for co-pays and deductibles are high and there isn’t a transparency to services and goods. So, getting back to the hospital bill, I had a recent procedure and the billing department in the doctor’s office sent off the wrong code of service and it ultimately delayed them getting paid. Had I not followed up in the first place I would have never known. I called the hospital where the surgery was done and found out through them of the missed code. The hospital was paid in full on their end because the billing department handled it correctly from the start. The revenue cycle of this particular hospital must be on point because I live in a rural area of the country where there are high numbers of low-income families per capita. Therefore, a lot of people are having to go without insurance, make payments, or receive charitable care. I know that the billing department has gone through a lot of change recently from Covid-19, but I don’t know what affects it has had on the hospital because of the pandemic. I do know that the government had and is still helping hospitals with a relief fund in the amount so far of $175 billion and more distribution in the amount of $ 10 billion to help offset the damages done (“HHS to begin distributing $10 billion in additional funding to hospitals in high impact COVID-19 areas,” 2020). I look forward to learning about the reimbursement side of healthcare throughout this term.ReferencesHHS to begin distributing $10 billion in additional funding to hospitals in high impact COVID-19 areas. (2020, July 20). HHS.gov. https://www.hhs.gov/about/news/2020/07/17/hhs-begin-distributing-10-billion-additional-funding-hospitals-high-impact-covid-19-areas.htmlClassmate #2:Michael Belanger posted Mar 1, 2021 6:07 PMI always eagerly anticipate these opening discussions and in this class, I feel as though I have some career experience to share and I’m excited about that!A little less than a year ago, my family and I decided to make a drastic change as my wife received an offer to work for Duke University, so we uprooted from Rhode Island and moved to North Carolina. In southern New England, I worked my way up in a small non-profit agency to a director’s level and ran a Medicaid funded program that served adults with developmental disabilities and severe behavioral challenges. I was responsible for coding and billing MassHealth (Medicaid) as well as communicating with other funding sources.During my tenure with the organization, I attended numerous state meetings with service providers when reimbursement rates were arbitrated. I had a nice behind the curtain peek at the inner workings of how that took place and knew first hand how rates could affect a small non-profit.One of the shortcomings was that the rates were a blanket, state wide rate. So, were cost of living were higher, like in Boston for example, programs like mine would be reimbursed at the same rate as say a very rural Western Massachusetts program. It was one number, regardless of the location. Additionally, there was a severity scale where individuals served were profiled yearly with clinicians and this profile determined severity, which determined reimbursement. High, medium and low severity respectively. It was very opinion based and could be easily manipulated if an agency or program chose to act in an unethical manner.All in all, I’m very interested in the content of this class and hope to learn from each other!
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