HA565 the Best Type of Health Insurance Assignment
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HA565 the Best Type of Health Insurance Assignment
HA565, Best, Type, Health, Insurance, Assignment
Glandon, G. L., Slovensky, D. J., & Smaltz, D. H. (2014). Information Systems for Healthcare Management. Chicago, IL: Health Administration Press.Chapter 13 “HIT Value Analysis”
Brown, G. D., Pasupathy, K. S., & Patrick, T. B. (2012). Health Informatics : A Systems Perspective. Chicago, Ill: Health Administration Press.Chapter 14 “Strategic Valuation of Enterprise Information Technology Architecture”
In not less than 200 respond
Imagine you are employed as an account professional in a health care organization. Which type of health insurance do you feel would be the most challenging to submit for reimbursement and in obtaining cooperation in obtaining payment?
In two different paragraph using their references give your personal opinion to Samantha Thompson and Marivette Bedoya
Marivette Bedoya
There are many different types of insurance plans, HMO, PPO, POS, and EPO, all of these are managed healthcare plans. Each type of health insurance plan will offer different options to obtain services, these services are obtained through a network (Horvath, 2019).
The health insurance network or service providers associated with your plan can make a difference for you because it may limit which doctors you can visit, or where you can get service.
Managed care plans work better for the individual person because in the long run they are more cost effective. Indemnity/reimbursement plans will usually see more out-of-pocket charges (deductibles and co-payments) and they many times place caps on the amount of benefits you can receive over the course of your lifetime.
Indemnity plans give you more freedom or flexibility, than managed care plans do in terms of using the healthcare provider of your choosing. So, depending on what a person wants, the choice between managed care and indemnity plans ultimately depends on your personal circumstances and preferences.If your goal is to minimize costs, you’re probably better off with a managed care plan.
HA565 the Best Type of Health Insurance Assignment
References:
Horvath, S. (2019, October 1). What is Health Insurance? Retrieved from https://www.benzinga.com/money/what-is-health-insurance/
Samantha Thompson
The following are the top 3 reasons that a practice doesn’t get paid for services performed.
“The patient isn’t eligible for the service provided. With the changing landscape of health insurance coverage, individuals and employees change insurance frequently, or key items in their coverage are excluded by their new plan. Demographic or other identifying information for the patient is missing or incorrect; this includes the spelling of the patient’s name, their exact address, Social Security number, and birth date, among other data.
The codes and modifiers on the claim form do not conform to the requirements of the patient’s insurance plan” (Medscape,2020). I believe that getting reimbursement from State covered insurance (Medicaid) is the most difficult. Medicaid has its own rules on what it deems medically necessary.
Many times there is a formulary that dictates the way the person needs to be treated and that doesn’t sit well with the doctors because they have their own plan of care. However if the doctor deviates from the State mandated plan to prove that their plan is the correct course of action, Medicaid will not pay and the patient is stuck with the hefty bill or the practice has to write the services off.
References:
Medscape, (2020). Collecting Effectively through Third Party Payers and Patients. Retrieved from: https://www.medscape.com/courses/section/870036
HA565 the Best Type of Health Insurance Assignment
RUBRIC
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Introduction 45-41 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Literature Support
91-84 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Methodology
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Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score
50-85%
40-38 points
More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.
83-76 points
Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.
52-49 points
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75-1 points
Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.
48-1 points
There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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HA565 the Best Type of Health Insurance Assignment