Question
Finance Assignment 1.
Identify the two activities on your unit by ICD-10 code. A list of ICD-10 codes can be found at the Center for Medicare and Medicaid Services (CMS) website.2. What types of reimbursement arrangement or contracts with third party payers are in place for these services?3. Who are major payers by percentages of revenue? For example, what percentage of reimbursement is from 1st-party payers, 2nd-party payers, and third-party payers? List the 3rd party payers.What are the high cost components of these high frequency activities?
Answer
Identify the two activities on your unit by ICD-10 code
The ICD-10 codes provide more accurate data compared with the earlier ICD-9 code system. The new code system is well suited to the current medical practices. The ICD-10 code for a patient who receives a hip replacement procedure can be written as Z96.649 (“CMS”, n.d.). This indicates an unspecified hip joint. The ICD-10 code for a patient who has undergone knee arthroplasty can be written as Z96.65. An artificial right knee joint can be written as Z96.651, and an artificial left knee joint as Z96. 652.
There are several contracts with third party payers in place for the services. Insurers are the most common third party payers who facilitate reimbursements. Health providers can enter into contracts with private insurers who are the most common or even public insurance which is currently taking shape (Altman & Frist, 2015). Other forms of reimbursement arrangements include the Blue Cross and Blue Shield organizations. Medicare also provides reimbursement arrangements but this only caters for patients above 65 years. Medicare is a federal program that covers over four major issues to patients. In line with this, the Medicaid program also provides reimbursement arrangements for the services provided. Lastly, Managed Care Organizations (MCOs) also provide reimbursement arrangements for the services provided. The MCOs provide healthcare and insurance to individuals (Altman & Frist, 2015).
The major payers by percentage of revenue are the 3rd party payers followed by the second party payers and lastly the 1st party payers. Third-party payers comprise of local government programs, state programs and federal-backed programs. The largest third-party payers include Medicaid and Medicare (Altman & Frist, 2015). These are public programs. There are also private third-party payers that mainly involve commercial health insurance companies some employers. Third-party payers contribute about 60 percent of the total hospital costs, while second-party payers contribute about 20 percent, and first-party payers contributing about 20 percent of the total costs. The high cost components include bed costs and equipment costs.
References
Altman, D., & Frist, W. H. (2015). Medicare and Medicaid at 50 Years: Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers. JAMA, 314 (4): 384–395.
Centers for Medicare & Medicaid Services (CMS). (n.d). ICD-10 Codes. Retrieved from: https://www.cms.gov/site-search/search-results.html?q=icd%2010%20codes
