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The Ineffective Approach in Medicare Reimbursement - Essay Example

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The ineffective approach in Medicare Reimbursement Issue Analysis Paper Name Institution Abstract The issue of reimbursement is crucial for nurses preparing for advanced roles such as those of management. Of most important is the approach used in arriving at the reimbursement amount in each hospital that APN in managerial roles need to understand while playing their roles…
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The Ineffective Approach in Medicare Reimbursement
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Download file to see previous pages On the other hand, the support on setting the Medicare reimbursement is that, there is no one general approach in which the most effective amount will be arrived at. In addition, the set guidelines and rules for Medicare reimbursement lack a proper structure making the approach more challenging to the practitioners. Nevertheless, the failure to involve the health practitioners, especially advanced nursing practitioners in management, effectively makes the approach ineffective. Therefore, their involvement is crucial to ensure an approach that suits the needs of all the stakeholders and making it responsive to the needs of both the patients and the healthcare providers. In addition, government intervention by creating proper legal guidelines is crucial to ensure that the approach meets the required needs. Keywords: reimbursement, Medicare, Medicaid The ineffective approach in Medicare Reimbursement Introduction Wong (1999) noted that, the Balanced Budget Act of 1997 provided the reimbursement of APNs for the services they provided in any given setting at a fraction of the physicians fee. Nevertheless, a long process requiring meeting specific guidelines and documentation makes the process of reimbursing APNs hectic and confusing. In this case, the new era of providing medical care should be devoid of the factors that do not in any way help in simplifying the process of reimbursement. Background Reinhardt (2003) identifies the Medicare reimbursement system in the country as a large one and much more centralized than in other countries. Moreover, the inflexible nature of the system does not offer any assistance but only helps make the issue much more complex for advanced practice nurses in management. In this case, this makes the system fail to respond to the local markets conditions, patients’ requirements, and more significantly to nursing care providers’ needs and requirements. Moreover, the unresponsive nature of Medicare is made worse by the rules and guidelines that groups of actors manipulate easily to meet their specific needs. Cohen and Spector (1996) noted that, the annual threat in a considerable cut in Medicare reimbursements often lead to speculation that hospitals will have a limit on the number of Medicare patients they admitted and treated. In effect, advanced nurses in charge of management faced a dilemma whether to admit these patients due to the cut in Medicare considering that the reimbursement formula to determine how much payment a hospital gets is determined by a particular number of cost-related factors and in particular the geographical location and inflationary rates. Position It is my position, as a nurse with advanced preparation in management, that the current Medicare reimbursement system is complex in its effort to offering quality care to the country’s population. In this case, the structure, rules, and guidelines on the reimbursement policy fails to capture the opinions of nursing practitioners on how best to structure the reimbursement policy. On the other hand, the structure of obtaining the reimbursement amount in terms of cost-related measures such as geographical location and inflation makes the policy on reimbursement appear unfair to some states and nurses practitioners while others benefit. In fact, this makes the policy more complex and puts management at an awkward position in terms of implementation of their policies. ...Download file to see next pagesRead More
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