Research (i.e., Internet, personal interviews, current employer, etc.) and describe the way the healthcare organization you selected uses a patient diagnosis/system for billing/coding (i.e., financing).(275 woord)

Research (i.e., Internet, personal interviews, current employer, etc.) and describe the way the healthcare organization you selected is reimbursed for the services provided to patients (i.e., financing).(275)

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Contemporary Issues in Healthcare: Financing

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Contemporary Issues in Healthcare: Financing

Patient Billing System

The Healthcare financing aspect provides the necessary resources and economic incentives designed to facilitate a functional health system. An effective healthcare financing system is a vital factor in promoting overall organizational performance and effectiveness. According to Damrongplasit & Atalay (2020), the billing process has an indispensable role in health care utilization: facilitating money mobilization, accumulation, and allocation. Resultantly, this helps to cover the individual and collective health needs adhering to equity, efficiency, and quality health outcomes. This essay aims to describe the Mayo Clinic Hospital’s utilization of the patient system for billing and reimbursement of services.

Mayo Clinic healthcare company is often ranked first among other top-performing hospitals in the United States due to its shared vision. Sir et al. (2017) explain that the non-profit organization concentrates on integrated healthcare, research, and education through multidisciplinary staff optimization. Mayo Clinic offers patients various payment methods, namely, Patient Online Services account, mail payment, Mayo Clinic number and date of birth, or in-person (cash) at the lobby registration desk. The organization uses the patient billing diagnosis to minimize medical errors by ensuring proper patient data entry (Damrongplasit & Atalay, 2020). Mayo Clinic utilizes its patient billing system as a vital process in perpetual functioning to ensure correct reimbursement for services provided to patients.

Additionally, the healthcare organization uses a patient billing system to streamline interfaces for managing hospital practice expenses. Using the most advanced technology, constantly informing its clinical staff, and creating awareness of contemporary trends, Mayo clinic works payments effectively; this is according to Sir et al. (2017). Subsequently, this improves the overall patient experience critical for demographic assessments and research studies. More significantly, treatment outcomes are enhanced through accountability-based reimbursement systems.

Reimbursement for Services

Healthcare funding by government agencies or private health insurers is essential for improved quality of patient services. Conferring to Ortiz-Ospina & Roser (2017), reimbursement models underscore cost-effective decisions regarding patients’ medical care through patient engagement apps and price transparency tools. Mayo Clinic is reimbursed in a variety of ways for the services they provide to patients.

Healthcare providers and hospital practitioners at May clinic are contracted with insurance plans from different organizations. The insurance company determines benefit coverage based on the specified medical benefit provision plan (Sir et al., 2017). Health Maintenance Organizations is another way used by Mayo Clinic to reimburse for its services. Although the organization does not collaborate with all HMOs, typical payments for Mayo Clinic Services are authorized prior from the insurance company. A deposit is requested for all unauthorized services based on the cost of service estimate, which in most cases are not paid in full. Actual charges may be greater or less than the initial deposit; therefore, requiring additional deposits.

Be that as it may, authorization before service delivery may not require a deposit, only additional services deemed necessary. Medical Assistance (Medicaid) is an accepted reimbursement method for provided services at Mayo Clinic. Ortiz-Ospina & Roser (2017) explain that some organizations have coverage limitations applicable for Medicaid programs, while others do not. For instance, at Mayo Clinic, limitations apply to Florida, Rochester, and Arizona.

Notably, due to their system alignment and coverage limitations, out-of-state Medicaid is not accepted. Patients covered by Medicaid health plans outside the states above are considered self-pay, requiring deposits of estimated charges. Medicare at Mayo clinic is also a reimbursement procedure with two billing parts. The first part allows patients to pay for hospital services, while the second part for clinic services, outpatient services, and doctor fees. In the end, which ever-patient billing system and reimbursement utilized for health service provision, it is crucial to ensure proper healthcare is administered to all patients.

Reference

Damrongplasit, K., & Atalay, K. (2020). Billing system and health care utilization: Evidence from Thailand. Journal of Health Economics73, 102366.

Ortiz-Ospina, E., & Roser, M. (2017). Financing healthcare. Our World in Data.

Sir, M. Y., Nestler, D., Hellmich, T., Das, D., Laughlin Jr, M. J., Dohlman, M. C., & Pasupathy, K. (2017). Optimization of multidisciplinary staffing improves patient experiences at the Mayo Clinic. Interfaces47(5), 425-441.