Insurance and Payment Expectations

Good Essays
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



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.

You May Also Find These Documents Helpful

  • Satisfactory Essays

    Payments Method

    • 263 Words
    • 2 Pages

    Payment Methods Fee-for-service is when a patient pays a fee for the services provided by a healthcare provider. According to Valerius et al. (2012), the more patients a physician sees in the fee-for-service, the more charges the health plan repays (section 1.4, p. 11). On the other hand, capitation payment cycles involve the first party, which is the patient, policyholder or employer (Valerius et al, 2012). Also the capitation payment cycle includes the second party, which is the provider…

    • 263 Words
    • 2 Pages
    Satisfactory Essays
  • Powerful Essays

    Balance of Payments

    • 18146 Words
    • 73 Pages

    (Financial Administration) SEMESTER IV MAJOR RESEARCH PROJECT ON BALANCE OF PAYMENTS SUBMITTED TO SUBMITTED BY Mr. MANEESHKANT ARYA ARUN SHRIVASTAVA CERTIFICATE INSTITUTE OF MANAGEMENT STUDIES DAVV, INDORE This is to certify that Mr. Arun Kumar Shrivastava, student of MBA (Financial Administration) Sem IV has worked under my supervision in the presentation of his research project titled “Balance Of Payment & Its Implications”. The project embodies the work of the candidate himself…

    • 18146 Words
    • 73 Pages
    Powerful Essays
  • Powerful Essays

    Balance Of Payment

    • 1336 Words
    • 8 Pages

    Balance of Payment Balance of Payment is the recording system of economic and financial flows that take place over a specified time period between residents and non-residents of a given country. The residents of a country compromise of the general government, individual, private and non- profitable bodies serving individuals and enterprises. The Balance of Payment will consist mainly with three sections. 1. Current Account- This shows all the inflows and outflows of a country. 2. Capital Account-…

    • 1336 Words
    • 8 Pages
    Powerful Essays
  • Powerful Essays

    Payment system

    • 2967 Words
    • 12 Pages

    students as possible. Payment is a key factor affecting relationships at work. The level and distribution of pay and benefits can have a considerable effect on the efficiency of any organization, and on the morale and productivity of the workforce. It is therefore essential that organizations develop payment systems that are appropriate for them, that provide value for money, and that reward workers fairly for the work they perform. Company and institution use a well-organized payment system that stabilized…

    • 2967 Words
    • 12 Pages
    Powerful Essays
  • Good Essays

    Payment of Bonus

    • 9414 Words
    • 38 Pages

    THE PAYMENT OF BONUS ACT, 1965 ACT NO. 21 OF 1965 [25th September, 1965.] 1*[An Act to provide for the payment of bonus to persons employed in certain establishments on the basis of profits or on the basis of production or productivity and for matters connected therewith.] BE it enacted by Parliament in the Sixteenth Year of the Republic of India as follows:-1. Short title extent and application. 1. Short title extent and application.- (1) This Act may be called the Payment of Bonus Act, 1965. (2)…

    • 9414 Words
    • 38 Pages
    Good Essays
  • Powerful Essays

    Terrorist Payment

    • 1336 Words
    • 6 Pages

    have been altered so not as to bias any discussion in class. On March 14, 2007 Chiquita Brands International entered into a plea agreement with the U.S. Department of Justice. Chiquita agreed to pay a $25 million fine after it admitted that it made payments to a terrorist organization for protection of its operations in Columbia. Teaching suggestions I find that this case works well when each ethical theory is used separately to analyze the situation. I begin by asking the students to summarize the…

    • 1336 Words
    • 6 Pages
    Powerful Essays
  • Powerful Essays

    balance of payment

    • 1467 Words
    • 6 Pages

    CHAPTER 3 BALANCE OF PAYMENTS SUGGESTED ANSWERS AND SOLUTIONS TO END-OF-CHAPTER QUESTIONS AND PROBLEMS QUESTIONS 1. Define the balance of payments. Answer: The balance of payments (BOP) can be de fined as the statistical record of a country’s international transactions over a certain period of time presented in the form of double-entry bookkeeping. 2. Why would it be useful to examine a country’s balance of payments data? It Answer: would be useful to examine a country’s BOP…

    • 1467 Words
    • 6 Pages
    Powerful Essays
  • Powerful Essays

    Mobile Payments

    • 13782 Words
    • 56 Pages

    Mobile Transactions and Payment Processing Ashok Goudar Senior Enterprise Architect White Paper Contents Introduction Mobile Commerce – Business Context Mobile Commerce Strategy Mobile Channel Strategy Mobile Marketing Mobile Sales Mobile Service Mobile Payment Mobile Wallets Mobile Commerce Transaction Mobile Banking and Mobile Money Mobile Commerce Transformation Roadmap Mobile Commerce – Payment Business Scenarios Card based Mobile User to Business – Payments (CM2B) Mobile – Wallet –…

    • 13782 Words
    • 56 Pages
    Powerful Essays
  • Powerful Essays

    E Payment

    • 13536 Words
    • 55 Pages

    Chapter 1. Introduction 1.1 Electronic payment systems and their place in electronic commerce 1.1.1 E-commerce and electronic payment systems 1.1.2 Limitations of traditional payment systems in the context of online payments 1.1.3 The need for new payment systems designed for e-commerce 1.2 User acceptance: understanding and issues 1.3 Research objectives 1.4 Research scope…

    • 13536 Words
    • 55 Pages
    Powerful Essays
  • Satisfactory Essays

    Insurance

    • 316 Words
    • 2 Pages

    University of Phoenix Material Insurance Matrix Directions – Matrix For each type of insurance listed in the matrix, identity three functions, three coverage characteristics, and three companies that offer this type of insurance. |Type of Insurance |Functions |Coverage Characteristics |Companies That Offer It | |Auto |…

    • 316 Words
    • 2 Pages
    Satisfactory Essays