Question

revsion of bold area and grammer check

TOPIC :

You are the manager at a home health agency. One of your elderly patients has insulin-dependent diabetes. He has no family support. He speaks limited english and has little understanding of his disease. He lives alone. Your reimbursement from a government agency pays $90 per visit. Because this gentleman needs so much care, you find that the actual cost to your agency is $130 for each visit to him.

1. What will be the impact to your agency if this patient is seen twice a week for three months?

2. How can you recover the lost revenue?

3. How can you make each visit less costly and still meet the needs of the patient? Support using one peer reviewed nursing article and your text book.

paper

Home health facilities are clinical rehabilitation organizations served by a certified rehabilitation physician, occupational therapist, physical therapist, or other trained medical providers. They are frequently suggested in the process of hospitalization as part of the treatment package. They offer a broad variety of services that can also postpone the need for long-term treatment. Studies have also shown that the burden of treating chronic conditions is reduced by treatment consistency (Henkel,2015). Treatment consistency leads to stronger communication between the patient and the doctor. The doctor also knows the patient background well in terms of treatment quality. It helps to identify and diagnose some diabetes-related symptoms early.

In this present scenario, one of these elderly patients is suffering from insulin-dependent diabetes, has no family support, lives lonely, speaks limited English and has little understanding of the disease he is suffering from. For a home health care agency and with government reimbursement of $90 per visitation, he needs a lot of care according to his condition. Essentially, $130 is the actual cost that is required for each visit. This man needs a lot of care twice a week for three months. If the patient is visited twice a week, the government reimbursement is $90 for every visit and agency actual cost is $130 for every visit. This leads to a financial burden on the home healthcare agency. This is because it is a private entity, which needs to meet patient demands as well as those of staff. The staff have to be paid for their services.

The cost-shifting [<I'm not sure if this is a good proposal. How about cross subsidization instead? Also, consider cost reduction/cutting.] procedure could restore lost revenue. The hospital charges two separate payments on two distinct classes [Can you elaborate what you mean by "classes"? Do you mean socioeconomic class of patients?] for the same care. The well-off group of patients spends extra for the care, which compensates for the money that the hospital has missed. As a manager, I [<Consider using third-person writing.] would source a billing company, which can rapidly make correct payments, facilitate the repayment system and minimize the amount of outstanding or rejected claims. Alternatively, I could hire billing professionals with specialist experience in home health care and can bill multiple payers, including Medicare, Medicaid, and exchange insurance, besides ensuring the revenue cycle is going smoothly. Comprehensive predictive technology could be chosen as it helps the home health billing provider's insight into financial service organizations by detecting patterns, finding missed sales prospects, and incorporating payer-specific information. The best billing agencies can be allowed to collaborate with home health departments to restore missing reclamations [Deficits of claim reimbursements?] to ensure that the facilities they deliver are adequately accounted for. Medicare covers a wide range of services to ensure it meets its beneficiaries' health needs, including reimbursement for a health care agency.

[Remember to remove spaces before and after paragraphs.]

The health care agency manager can also opt for the following:

1. Right arrow acute billing [Do you mean to bill for acute care as much as possible? I recommend you consider Fraud, Waste, and Abuse (FWA).], which turns around fast. It can choose a billing company that is able to surrender to quickly clean and precise [process?] claims. It can also speed up reimbursement process thereby reducing unpaid claims or denial claims.

2. Right arrow billing expertise - the healthcare agency should hire staff [How about outpatient medical coders?] billing experts with appropriate knowledge who can poster a number of financiers that include Medicaid and Medicare thus ensuring smooth running of the revenue cycle.

3. Right arrow web based analytical technology - billing companies offer complete analytic technology that provides [> intuition financial matters of the intervention financial health <I'm not sure what you mean here.] by observing tendencies, identifying lost chances and enhancing payer-specific analysis.

4. Right arrow billing recovery will specialize at managing the due entitlements and aged accounts. Top billing companies will toil hand in hand with home-based healthcare agencies to recuperate some lost entitlements for poor services and payment provided.

By approaching through the above outlined methods, the agency can regain and bring back lost revenue. Early diagnosis decreases the additional hospital costs. The entities above utilize billing skills to charge a range of payers such as Medicare and Medicaid because the home health provider's payment would be paid by Medicare to satisfy beneficiaries' demands. Physicians may decrease the expense of treating by recommending a low-priced form, such as generic medicine rather than an advertised drug. If there is not a safe alternative, a cheaper substitution should be recommended.

[Remember to include a reference list. For APA 7 format, type "References" in bold and center it.]

Henkel, R. J., & Maryland, P. A. (2015). The Risks and Rewards of Value-Based Reimbursement. Frontiers of health services management, 32(2), 3-16.

Answer 1

Home health facilities are clinical rehabilitation organizations served by a certified rehabilitation physician, occupational therapist, physical therapist, or other trained medical providers. They are frequently suggested in the process of hospitalization as part of the treatment package. They offer a broad variety of services that can also postpone the need for long-term treatment. Studies have also shown that the burden of treating chronic conditions is reduced by treatment consistency (Henkel, 2015). Treatment consistency leads to stronger communication between the patient and the doctor. The doctor also knows the patient background well in terms of treatment quality. It helps to identify and diagnose some diabetes-related symptoms early.

In this present scenario, one of these elderly patients is suffering from insulin-dependent diabetes, has no family support, lives lonely, speaks limited English and has little understanding of the disease he is suffering from. For a home health care agency and with government reimbursement of $90 per visitation, he needs a lot of care according to his condition. Essentially, $130 is the actual cost that is required for each visit. This man needs a lot of care twice a week for three months. If the patient is visited twice a week, the government reimbursement is $90 for every visit and agency actual cost is $130 for every visit. This leads to a financial burden on the home healthcare agency. This is because it is a private entity, which needs to meet patient demands as well as those of staff. The staff have to be paid for their services.

The cost-shifting procedure could restore lost revenue. The hospital charges two separate payments on two distinct socio economic classes for the same care. The well-off group of patients spends extra for the care, which compensates for the money that the hospital has missed. Costcutting cand be done by prescibing generic medicines.As a manager, one should source a billing company, which can rapidly make correct payments, facilitate the repayment system and minimize the amount of outstanding or rejected claims. Alternatively, one should hire billing professionals with specialist experience in home health care that can bill multiple payers, including Medicare, Medicaid, and exchange insurance, besides ensuring the revenue cycle is going smoothly. Comprehensive predictive technology could be chosen as it helps the home health billing provider's insight into financial service organizations by detecting patterns, finding missed sales prospects, and incorporating payer-specific information. The best billing agencies can be allowed to collaborate with home health departments to restore missing reclamations to ensure that the facilities they deliver are adequately accounted for. Medicare covers a wide range of services to ensure it meets its beneficiaries' health needs, including reimbursement for a health care agency.

The health care agency manager can also opt for the following:

1. Right arrow acute billing to bill for which turns around fast. It can choose a billing company that is able to surrender to quickly clean and precise claims. It can also speed up reimbursement process thereby reducing unpaid claims or denial claims. The FWA method can also be used to recover the lost revenue by adding more tests or medicines in the bill than prescribed by the physician.

2. Right arrow billing expertise - the healthcare agency should hire staff billing experts or outpatient medical coder with appropriate knowledge who can poster a number of financiers that include Medicaid and Medicare thus ensuring smooth running of the revenue cycle.

3. Right arrow web based analytical technology - billing companies offer complete analytic technology that provides by observing tendencies, identifying lost chances and enhancing payer-specific analysis.

4. Right arrow billing recovery will specialize at managing the due entitlements and aged accounts. Top billing companies will join hand in hand with home-based healthcare agencies to recuperate some lost entitlements for poor's services and payment provided.

By approaching through the above outlined methods, the agency can regain and bring back lost revenue. Early diagnosis decreases the additional hospital costs. The entities above utilize billing skills to charge a range of payers such as Medicare and Medicaid because the home health provider's payment would be paid by Medicare to satisfy beneficiaries demands. Physicians may decrease the expense of treating by recommending a low-priced form, such as generic medicine rather than an advertised drug. If there is not a safe alternative, a cheaper substitution should be recommended.

Henkel, R.J and Maryland , P. A(2015). The Risks and Rewards of Value- Based Reimbursement. Frontiers of health services management.

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