Financial Basics

MHA FPX 5006 Assessment 1 The income for health professionals comes in different forms, each with their requirements and reimbursement processes. Understanding these complications is important for refund and general success. Primary sources of income for suppliers include Medicaid, Medicare and managed care coverage. Each has specific rules that control refunds, which affects how to pay for the services to register. The purpose of this presentation is to fly into these income models, clarify their purpose and reimbursement mechanism.

 Medicaid 

Medicaid created in 1965 under the Social Security Act provides health insurance for people with low incomes including disabled people, children and the elderly in long -term care. Together managed by federal and state authorities, varying in the medical states, causing coverage inequalities. Reasonable care law expanded eligibility criteria, which enables extensive rules for coverage and standardization. The reimbursement process for Medicade is ready to cover medical services for financially disadvantaged individuals, excellent by the state, and presents complications in understanding and navigation of its needs. Medicade provides two main payment models: fee-to-service and managed care. The fee-service model reimburses suppliers for individual services, which potentially encourages overgrowth. On the other hand, the managed care model focuses on general patient care, and allocates a certain payment regardless of the services offered, the goal is to balance quality and cost efficiency.

 Medicare 

Medicare, initiated in 1965, ensures healthcare access for individuals aged 65 and above, along with those with specific disabilities. Managed by the Centers for Medicare and Medicaid Services (CMS), Medicare comprises Parts A, B, C, and D, each covering distinct services. Reimbursement under Medicare involves coding services appropriately according to each part’s requirements, with claims processed by Medicare Administrative Contractors (MACs). Reimbursement mechanisms differ among parts, influencing provider reimbursement and patient responsibility.

Managed Care

MHA FPX 5006 Assessment 1 Managed care plans work together to provide cost -effective care with suppliers, emphasize patient welfare and preventive measures. Three general types include the Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Point of Service (POS) plans, which are different in flexibility and cost sharing. Managed reimbursement of unnecessary services and clear payment mechanisms mentioned in contracts. Payment methods include risk -based payments, premium percentage, global fee, caption and concessional fee service, income streams and distribution of care of suppliers that affect each.

Conclusion 

Discussed income models are integrated parts for the economic stability of health organizations and the quality of patient care. Understanding and navigation of reimbursement processes ensures that suppliers are optimal care to maintain economic viability, and eventually promote long -term organizational flexibility.

References 

Centers for Medicare and Medicaid services. (Raw.). The history of the program. Centered for Medicare and Medicaid Services: www.medicaid.gov/bout-s-/programhistory/index.html Hurley, R., and Retchen, S (2006). Medicare and Medicaid Managed Care: a story of two orbits. American Journal of Managed Care.