Insurance and Payment Expectations
HEALTHCARE PAYMENT EXPECTATIONS
Unit 1 Individual Project
Tina Nguyen
HLTH420 – Healthcare Finance
November 7, 2012
Abstract
This research paper will explain the payment expectations of government, commercial, and liability insurances, as well as self-pay/cash pay patients. An in depth explanation of how they differ, such as rules, will be made. This report will help readers understand the different types of programs in bill collecting, and account and project financial expectations.
Healthcare Payment Expectations Payment expectations are the reimbursement of the services given to patients. There are many alternatives to how healthcare organizations collect their payments or revenues. They can be handled through cash transactions or through various types of insurances, such as government-assisted, commercial, and liability insurances. Some of the health insurances that are government-assisted are Medicare, CHIP, and Medicaid. Government-assisted insurances, such as Medicare and Medicaid, are provided for low income families and adults over the age of 65 or even those under 65 that has certain disabilities (USA.gov, 2012). Medicaid’s health coverage will vary by states, as they will set their own rules and guidelines. In order to be granted for these government health insurances, an individual must meet certain criteria to be eligible, depending on which program it is catered for (New Horizons Un-Limited Inc., 2011). Payment expectations of government-assisted health insurances, such as Medicaid, are reimbursed through co-pays, and premiums (“Medicaid Payment Expectations, “ n.d.). As mentioned before, payment expectations will vary by state but should not be much different. Co-pays are the rate at how much is to be paid for the services or a prescription a patient will be receiving (“Medicaid Payment Expectations,” n.d.). Co-pay rates are rates that are agreed upon by the Medicaid program and type an individual has. Premiums are out of
Unit 1 Individual Project
Tina Nguyen
HLTH420 – Healthcare Finance
November 7, 2012
Abstract
This research paper will explain the payment expectations of government, commercial, and liability insurances, as well as self-pay/cash pay patients. An in depth explanation of how they differ, such as rules, will be made. This report will help readers understand the different types of programs in bill collecting, and account and project financial expectations.
Healthcare Payment Expectations Payment expectations are the reimbursement of the services given to patients. There are many alternatives to how healthcare organizations collect their payments or revenues. They can be handled through cash transactions or through various types of insurances, such as government-assisted, commercial, and liability insurances. Some of the health insurances that are government-assisted are Medicare, CHIP, and Medicaid. Government-assisted insurances, such as Medicare and Medicaid, are provided for low income families and adults over the age of 65 or even those under 65 that has certain disabilities (USA.gov, 2012). Medicaid’s health coverage will vary by states, as they will set their own rules and guidelines. In order to be granted for these government health insurances, an individual must meet certain criteria to be eligible, depending on which program it is catered for (New Horizons Un-Limited Inc., 2011). Payment expectations of government-assisted health insurances, such as Medicaid, are reimbursed through co-pays, and premiums (“Medicaid Payment Expectations, “ n.d.). As mentioned before, payment expectations will vary by state but should not be much different. Co-pays are the rate at how much is to be paid for the services or a prescription a patient will be receiving (“Medicaid Payment Expectations,” n.d.). Co-pay rates are rates that are agreed upon by the Medicaid program and type an individual has. Premiums are out of
References: Carter, J. (2011, November 7). How Self-Pay Patients Have Made Me a More Effective Clinician. Retrieved from http://www.mikereinold.com/2011/11/how-self-pay-patients-have-made-me-a-more-effective-clinician.html. Medicaid Payment Expectations. (n.d.). Retrieved from http://member.indianamedicaid.com/programs--benefits/important-things-to-know/payment-expectations.aspx. New Horizons Un-Limited Inc. (2011, September 30). Government Financial Assistance Programs. Retrieved from http://www.new-horizons.org/carfgv.html. Texas Department of Insurance. (2012, January 24). The Medical Liability Insurance Shopping Guide. Retrieved from http://www.tdi.texas.gov/commercial/pcmedmal.html. USA.gov. (2012, October 23). Health Insurance. Retrieved from http://www.usa.gov/Citizen/Topics/Health/HealthInsurance.shtml. Wall, J. (2010, October 20). 'Payer mix ' playing role in hospital merger. Retrieved from http://www.ibj.com/payer-mix-playing-role-in-hospital-merger/PARAMS/article/22925. What Is Commercial Health Insurance? (n.d.). Retrieved from http://www.wisegeek.com/what-is-commercial-health-insurance.htm.