Medicare and Medicaid Reimbursement to Providers - Essay Example

In addition to accurate information, information technology plays a vital role in making Medicare and Medicaid reimbursement process easier and faster. Offices have medical billing software that automatically compile, enter, and format universal outpatient billing claim form; however, changing information technology alone cannot sustain an ease of access in obtaining and sharing health information in the Medicare and Medicaid process, particularly organizational changes about payment. Therefore, this paper will discuss how the organization can have a better payment and communication system through suggesting a constant associate that would deal with the provider’s need for information and designating a certain time frame to receive the payment.

The Proposed Change History of the organization and the need for change. The history of the Centers for Medicare and Medicaid Services began when the Medicare and the Medicaid programs were signed into law on July 30, 1965 by President Lyndon B. Johnson. It was then subjected to legislative change by George W. Bush on December 8, 2003 and became the Medicare Modernization Act which has added an outpatient prescription drug benefit to Medicare (Centers for Medicare and Medicaid Services, 2012, n.p.). . In addition, it reflects that the comprehensive health reform focuses on a new model for broader payment and delivery system.

In relation to the proposed change, the author thought that the organization can have a better system in place when there is a certain time frame to receive the payment and when the same associate communicates information every time a provider calls in to get information about payment, instead of dealing with other associates to start over from the beginning. Assessment revealed that the organization has the need for change to broaden the payment and delivery system and improve care coordination between providers, associates, and settings.

Organizational and individual barriers. The presence of individual and organizational barriers hinders the provision of a timely and appropriate Medicaid and Medicare services. Individual barriers include attitudes, knowledge, beliefs, culture, and training of providers and patients while organizational barriers include financing or payment policies (Mauch, Kautz, & Smith, 2008, 11). Receiving reimbursements under Medicaid and Medicaid must be in line with the payment structures, billing methods, state business customs and federal laws and regulations.

Under the federal law, there are 12 services which were mandated to provide as a condition of participation in the Medicaid and Medicare program (Mauch, Kautz, & Smith, 2008, 11). It is the State which has the influence towards organizational payment policies and thus, may contribute to the success or failure of the proposed change in the reimbursement process. Restrictions on same-day billing also impede Medicare and