REIMBURSEMENT AND PROFITABILITY
QUESTION
Write a 500-600-word essay that describes the following points:
1. Explain what cost shifting is and its relationship with different payers (Medicare, Medicaid, third party insurers, uninsured, etc.).
2. Describe the importance of remaining profitable by appropriate price negotiations and contracting for service.
Include one scholarly source in addition to your textbook.
prepare this assignment according to the guidelines found in the APA Style Guide
REIMBURSEMENT AND PROFITABILITY
ANSWER
REIMBURSEMENT AND PROFITABILITY
Introduction
There is a loss of revenue in healthcare institutions across the globe because of reduced reimbursement rates with the medical field entailing facilities, healthcare providers, and insurance companies. The loss of revenue for services has led to cost-shifting being a vital source for the healthcare institutions to recover the difference of reimbursing the lower public player.
Question 1
Cost shifting is an economic activity that permits institutions to fulfill the cost demands by shifting the liabilities to the other payers. When a group, a person, or the government pays less for a service, another group, person, or government overpays for the service. Thus, in the medical field, the expenses are shifted from the public payer patients like Medicaid and Medicare, who pay less for the series, to the private payer patients like cash payers who are charged more for their services. Thus medical cost-shifting charges the private partners more to cater for the gaps with the public payments (White & Whaley 2019).
There is a relationship that cost-shifting has with various payers, which aids in comprehending the negatives and positives based on what side of the line an individual is at. This is whether a person is a private or public-payer patient. Regulating incorrect or partial insurance claims can be expensive to the buyers and providers (Cleverley et al., 2011). Correcting and refiling a payment or claim can be labor-intensive for all the parties, and it leads to issues that lead to reduced overall satisfaction. Also, when providers lose revenue or accurate and timely payers, it leads to disruptions in providers catering for their responsibilities to their stakeholders’ employees. Also, it creates challenges in fulfilling different financial obligations.
Question 2
To always be profitable there, an institution must control its contracts and management to attain a financial breakthrough. A simple criterion to comprehend the significance of an organization always being profitable is accessing the long-term cost-shifting. Despite different reasons for suitable contracts and negotiations, this can be termed as one of the most straightforward and accurate reasons to bill for services offered correctly, adhere to the reimbursements, and cost-shifting (Barney, 2018). As an employer, they have dictated increased costs to their workers to cater to the increasing healthcare expenses. A study offered by the Centre for American Progress outlines that patients will spend less on healthcare if they are subject to increased fees. Also, some may believe that public health insurers, programs, and employees benefit from this mode of thinking. However, the healthcare employees and practitioners suffer because there is insufficient billing and services offered. In a nutshell, if a healthcare practitioner does not have the billable services, they cannot accomplish their financial breakthrough.
Conclusion
Cost-shifting seems to be a remedy for many institutions in various fields. This would help ensure that even those who cannot fully cater for their bills because of lack of enough funds, caused mainly by low living standards, equally access services. In the medical field, if the providers cannot ensure recovery of the expenses from the different types of taxpayers, there would be a lot of facilities and providers unable to fulfill their cost demands to offer a high and quality standard care. Also, in some cases, patients with chronic diseases may have a burden catering to the high costs of treating their conditions. Thus, cost-shifting is an appropriate strategy.