Healthcare Reimbursement Information 2022

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Healthcare reimbursement
Institution:
Name:
Date:
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Introduction
Sinai Hospital of Baltimore is a ten roomed hospital that was established in 1866 to cater
to the needs of Jewish patients and medical specialists. It is a private hospital based in the
northwest of Baltimore County. They have one superintendent, administrator, cashier, six
nursing staff, one occupational therapist, and three call Centre reps, a cafeteria and maintenance
workforce. Sinai Hospital is a small medical facility with approximately 50 beds for
rehabilitation and long term care plan. The facility is encountering reimbursement and revenue
collection challenges.
Healthcare reimbursement.
Reimbursement is referred to as the circulation of finance in a health care system. The act
is a medical and managerial role, which contribute to capturing, management and gathering
payments from the patients. It is accounting for all operations of a patient. Revenue circulation is
supposed to ensure that patient's account balance is nil. The process begins when calls for an
appointment that ends when all the things are collected. Hospital's workforce is mandated to
ensure they capture patients’ details well, including full name, cellphone contact, and scheme
cover details (Souliotis et al., 2016). Various stages need to be considered from the start to
ensure that everything is well set. Failing to capture insurance cover details during setting up of
appointments, for instance, might lead to time wastage and money when it’s determined that a
patient’s health-care cover is not acknowledged.
Patients are found to take extra financial costs amount obligation to cater to their health
charges through various medical insurance that patients have to select. These vary in several of
co-insurance and co-payments, alongside the annual maximums of the spend expenditure for
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patients and their families (Green, 2018). If the insurance confirmation procedures are not
completed, some of the issues that will be encountered are that patent’s claim is denied, improper
collection of co-payments, collection of wrong forms, which takes place some weeks after the
patient is attended. Insurance confirmation is a starting point, and it's the most crucial point, to
request disbursement from the insurance cover for the facility. Furthermore, if this practice is not
well documented it will end up in denial of the claim or the delayed payments for an extent of
one to three months beyond the recommended payment turnaround period of two weeks to two
months.
Revenue collection is a crucial component for the reimbursement procedures of medical
facilities. There are various measures of the process that are responsible for their roles and these
roles combine into the overall objective of delivering blameless claims for the services provided
at the medical setting (Glaser, 2010). The initial section of the revenue process is the front-end,
which consist of paying negotiation that takes place without the experience of the patient,
admission element that involves preparing patient for outpatient and inpatient services,
registering, verifying insurance, obtaining prior authorization, and patient financial advice.
In the cycle, the medical staff will provide essential support and services required for
admission the services needed for the admission, and ensure that required essential documents is
available. This section handles the bills, post-payment, adjusting any claim that was rejected due
to faults, appealing all denials that are not correct, and supplying any extra documentation
required as well as making corrections.
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This entire process is an achievement by balancing people, procedures, the technology employed
in support of the process, and the surrounding where procedures are prepared within Hospital
Model of Revenue Cycle Workflow Sinai Medical Center.
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