US Healthcare Reimbursement and Billing System

Part 1:  Role of finance in the healthcare system Finances, has a primary role in planning, obtaining and confirming the availability of required materials for the increase in productivity in the business. Through the role of finance in healthcare, they ensure that healthcare systems are kept organizational, and every activity in the health system are running smoothly without any interference (Gapenski, 2012). The concept of financial management helps the healthcare service to identify in cash inflow and outflow in the industry. However, for the finance to work effectively in the healthcare industry, it requires four elements which include, Organizing, controlling, decision making and planning. Organizing and directing This is using the resources that are in the healthcare sector to ensure that all the plans set in the industry have been established.

These codes are used for hospital facility claim only. c) Medicare Severity Diagnosis Related Groups (MS-DRG’s) These codes are only utilized to inpatient admissions. This is a system used to classify Medicare patients’ hospital stay in groups that enable the facilitation of service payment. It enables increase reimbursements to the hospitals that serve more severely ill patients. d)Ambulatory Patient Classification (APC) These are the methods of paying for facility outpatient service and are specifically for outpatients claim in the healthcare industry. Private Insurer These insurers provide the monthly monetary fee for the chosen plan coverage. The offer different plans to individuals in the United States and it all depends on the coverage that an individual requires. An example of the private insurer is Blue Cross Blue Shield.

Part 4: Reimbursement methods used and the effects of coding on reimbursement  Fee-for-service This is a model of payment that allows the providers to receive fees depending on the service they have offered. Thus the providers will receive fees on each separate service they have provided. Conclusion Finance has a major role in the healthcare industry. However, it requires four elements such as planning, decision making organizing and controlling for it to be effective. This will enable the smooth running of the health sector in the country. Besides, coding although is used to determine reimbursement in the facility; it can either have a negative or positive effect. Therefore they provide need to report accurately to avoid the complications that down coding and up coding can bring in the health sector.