Healthcare Reimbursement

Healthcare Reimbursement

In my article report I will discuss three distinct articles or journals which focused on healthcare reimbursement. The first journal was about how the government and nonprofit human service organization negotiate cost reimbursement for services provided to the persons with disabilities in the state of Kansas. The disabilities mentioned range in circumstances of Autism, Down's syndrome or Cerebral Palsy to severe mental illness which include Bipolar Disorder, Schizophrenia and Depression. The government depends on nonprofit organizations to deliver services and nonprofit organizations depend on the government for support. In the case study implemented in Sedgwick County, which includes the largest city in Kansas, community based services is a dominant tenet of Medicaid reimbursements and accounts for 25 percent of all Kansas state expenses. In Kansas, a community developmental disability organization (CDDO) and community mental health center (CMHC) are designated as the local authority. It has agreements with sixty private, primarily nonprofit organizations to provide services. Nonprofit organizations in Sedgwick County "partners" or have a formal written agreement with the CDDO and CMHC which allows organizations to bill through the CMHC or CDDO and be reimbursed by Medicaid. The service providers are paid at a set rate for each service covered by the state's Medicaid plan.
The second article is about how physicians who don't participate in the 2013 Physician Quality Reporting System (PQRS) will see the effects of their nonparticipation in their 2015 Medicare reimbursement rates. PQRS was designed in 2007 to support improvements in quality of care by requesting a set of quality measures to be reported by the physician annually. As reward for receiving data provided by the physicians, the practice earned incentive payments. As the program has continued, however, the incentive payment has decreased incrementally to the current 0.5% percent of total claims. PQRS...

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