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Given what you've learned in the class, what are some key factors that influence health insurance,...

Given what you've learned in the class, what are some key factors that influence health insurance, billing and reimbursement? Discuss reimbursement methodologies, current issues, and legal/governmental influences. Based on your discoveries, what action plans would you put in place to have these factors impact your departments in a positive way?

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Answer #1

key factors influence health insurance:

Body mass index

Gender

Tobacco use

Ore existing medical condition

Family history

Billing and reimbursement:

Medicare beneficiary

Economic status

Influence of private insurance.

Emerging and re emerging of diseases..

Reimbursement methodology:

1. Fee for service reimbursement

2. Fee for. episode reimbursement.

Current issue:

1. New cure is expensive

2. Medical technology is expensive

3. Abuse of service

4. Fraudulent claim

5. Duplication if tests.

Governmental influence:

1. Based on type of health care delivery system.

2. Identify future trend in health care.  

3. Influence of political activities in health care.

4. Current health care policy

5. Health care regulations.

Actions impact on positive way:

1. Quality of health care.

2. Continuing medical education

3. Adequate training of personal.

4. National health policy

5. Various control programs.

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