Nobody downloaded yet

The Ineffective Approach in Medicare Reimbursement - Essay Example

Comments (0) Cite this document
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…
Download full paperFile format: .doc, available for editing
GRAB THE BEST PAPER95% of users find it useful
The Ineffective Approach in Medicare Reimbursement
Read TextPreview

Extract of sample "The Ineffective Approach in Medicare Reimbursement"

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
Cite this document
  • APA
  • MLA
(“The Ineffective Approach in Medicare Reimbursement Essay”, n.d.)
The Ineffective Approach in Medicare Reimbursement Essay. Retrieved from
(The Ineffective Approach in Medicare Reimbursement Essay)
The Ineffective Approach in Medicare Reimbursement Essay.
“The Ineffective Approach in Medicare Reimbursement Essay”, n.d.
  • Cited: 0 times
Comments (0)
Click to create a comment or rate a document

CHECK THESE SAMPLES OF The Ineffective Approach in Medicare Reimbursement

Medicare Funding/Reimbursement

...?The Financial Health of Medicare and the Services Offered Medicare is a program of health insurance that is for people who are either above the age of 65, or they have certain disabilities and are under 65. The program was initiated in 1965 through the passing of an act in parliament and is now a widespread program, with spending totaling over $11.7 billion in 1999 alone . The program works by providing reimbursement for the services and expenses occurred by inpatient care, doctors services, outpatient care and prescriptions . Individuals pay premiums to be part of the insurance system. This is often provided as part of employment , with spouses also being covered on many occasions ....
3 Pages(750 words)Essay

Medicare and Medicaid Reimbursement to Providers

...? Medicare and Medicaid Reimbursement to Providers Medicare and Medicaid Reimbursement to Providers Introduction The Medicare and Medicaid reimbursement process has organized steps or flows that facilitate collection, access, obtaining, and sharing of patient’s health information (Richards, 2010, 34). Accurate information serves as the foundation of a systematic Medicare and Medicaid reimbursement process and contributes to the ease of access in obtaining and sharing information. An associate or reimbursement specialist has the responsibility to make sure that all the necessary...
4 Pages(1000 words)Essay


...June 15, Reimbursement Reimbursement is a term used to refer to the process of refunding money to a given party for expenses or losses incurred. Due to the escalating expenses incurred as a result of tobacco usage in the United States of America, there is debate on whether tobacco companies should reimburse the government for health expenses. The aim of this paper is to discuss why tobacco companies should reimburse the government for health care expenses related to tobacco use. Accountability Tobacco companies have, over the years, created an uncontrollable desire to use tobacco products such as cigarettes. Over time, these products have brought about major health...
4 Pages(1000 words)Essay

Tuition Reimbursement Implementation Report

...? Tuition Reimbursement Nam e Tuition Reimbursement Tuition Reimbursement Implementation strategy has been embraced by most of the business today given the positive results that are realized in the program. While the critics of the program will argue that when the employees are enabled to upgrade academically, they are most likely to be poached by other businesses, concluded research denounce this and in the contrary indicates that the program only facilitates employee retention capacity. This is owed to the fact that most of the employees will feel a sense of belonging to the business and consider themselves as being in kind of a family set up in which the needs of an individual is a...
4 Pages(1000 words)Essay

Medicare Reimbursement

...? Medicare Reimbursement Scenario Medicare is an insurance provided by government to cover supplies and the services that are needed for the treatment of a medical condition (Medicare, 2013). Mrs. Zwick has Medicare part A, B, and D. Since Mrs. Zwick was hospitalized for mild stroke for 5 days she also qualifies for SNF (Skilled Nursing Facility). Part A is activated when the doctor has ordered the inpatient treatment of an illness and it can only be treated in hospital. Mrs. Zwick is eligible for the SNF since she needed daily skilled care and had developed a hospital related medical condition. Part A will cover the inpatient expenditures of Mrs. Zwick since she was in SNF a whole of 40 days. Part A covers full expenses for SNF... for the...
4 Pages(1000 words)Essay

Answer the questions in Bold

...of both general and specialized administrators. The management of health care services in the United States requires a constant awareness of expenses and budgets. Reimbursement caps already make the administration of Medicare and Medicaid a difficult process, but the increasing and aging population will put more economic stress on the system than ever before. Expenses will continue to increase due to other factors as well, including those related to hiring more professionals as will be necessary. Managing Technology Technology is a major driver in practically every aspect of the health care system, and administration is no exception. As new technologies become available to aid in the delivery process,...
4 Pages(1000 words)Essay

U07d2 Reimbursement Reform

...Running Head: u07d2 REIMBURSEMENT REFORM u07d2 Reimbursement Reform Submitted by: Setara Azizi Number: XXXXXXXXX Capella Name: The extremely serious events and the adverse events in the health care industry which could have been prevented are referred to as the ‘Never Events’. This report aims at discussing the specifics of the October 2008 Final Rule implementation about the ‘never events’ and the cases of non payments. The main underlying reasons for the ‘never events’ has basically been the human errors. The term ‘never events’ was coined by the Medicare and Medicaid listed out a number of events that could have been reasonably prevented. This list was developed with based on number of consultations with the stakeholders... and the...
2 Pages(500 words)Essay


...Medicare Introduction Medicare is the health insurance program in the United s for individuals who are 65 years old and above (Social Security Online, 2010). People with disabilities and those with permanent kidney failure as well as those with amyotrophic lateral sclerosis also qualify under this program. Medicare coverage is not complete as it covers a portion of the cost of health care and the cost of long-term care (Social Security Online, 2010). This program is financially supported by payroll taxes which are paid by workers and employees and also by the monthly payments deducted from Social Security checks (Social Security Online, 2010). It is a program being implemented by the Centers for Medicare & Medicaid Services... . ...
5 Pages(1250 words)Research Paper

Effective vs. Ineffective Language

...Effective vs ineffective language Introduction Effective language refers to the use of application methods to learning language on the internet and other useful aiding material. The software is specially customized for such learning. Effective language involves more than these methods as support for second learners in their survival where they have to live among native speakers. Effective language process ensures that there is enough time for learners to achieve competence in a certain acquired language as well as focus on students as the center of learning process. It is classified according to its effectiveness in the learning process. Ineffective language happens as a result of failure of attainment...
1 Pages(250 words)Essay

Medicare the beneficiaries fail to get the required services. With reimbursement of funds being a major challenge, it is obvious that the persons with chronic conditions will not help as they would wish. On a deeper insight, it is evident that the population is growing by the day. Schieber, et al (2009) write that as soon as the younger generation get to their old age, the healthcare system will not provide the required services to the aged. This fact explains the reason behind the healthcare services being very expensive for a majority of US citizens. The Medicare challenges affect a huge percentage of people, organizations and even government agencies. However, it is very crucial to note that the tax...
6 Pages(1500 words)Research Paper
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.

Let us find you another Essay on topic The Ineffective Approach in Medicare Reimbursement for FREE!

Contact Us