Description
Discussion: Participation in Government-Sponsored Plans
More than one fourth of all healthcare services are paid by the federal government, making it the largest single payer of health care in the United States (Troy, 2015, p. 1). For providers, dealing with the nations largest payer requires a deep understanding of the different government-sponsored plans in terms of coverage, rules, and regulations related to care and payment for services (Harrington, 2021). Because there are so many options for coverage and payment, it is important for the healthcare administrator to understand proper billing procedures to help maintain the financial health of the organization he or she represents.
In this Discussion, you examine different government-sponsored healthcare plans and then discuss how participation in these plans impacts healthcare providers.
References:
Harrington, M. K. (2021). Health care finance and the mechanics of insurance and reimbursement (2nd ed.) Jones & Bartlett Learning.
Troy, T. D. (2015). How the government as a payer shapes the health care marketplace. Retrieved from http://www.americanhealthpolicy.org/Content/docume…
To prepare for this Discussion:
- Review this weeks Learning Resources.
- Choose one of the following government-sponsored plans on which to focus for this Discussion:
- Medicare
- Medicaid
- Childrens Health Insurance Program
- TRICARE
- CHAMPVA
- Worker’s Compensation
- Indian Health Services
- Review the assigned chapters from Harrington (2021) and review the Centers for Medicare and Medicaid Services (CMS) homepage for information on the plan you chose.
- Find at least one current, reputable online source (e.g., .org, .edu, .gov, or .mil) that discusses the challenges providers face regarding government-sponsored plans such as in the example of Mosaic Internal Medicine in this weeks Introduction. These could be financial challenges, quality of care issues, constantly changing rules and regulations, or any other challenge you may find.
By Day 4
Post a comprehensive response to the following:
- Identify and describe the basic characteristics (e.g., the beneficiaries, services covered, who administers it, etc.) of the plan you chose.
- Outline the eligibility requirements for coverage for the targeted population.
- Discuss how participation (or lack of participation) in the plan impacts healthcare organizations.
Provide specific examples in your response. Support your post with the Learning Resources and at least one outside scholarly source.
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