The health care organizations are usually required to manage their revenue and expenses to earn more profit or surpluses whether they are taxable or tax-exempt. The healthcare organizations encompassing hospitals and physicians are unique in the way in which they receive reimbursement for the services they offer to the general patient population to improve the health of the patient. Since the healthcare services are always offered before the payment is made, it is required that the physicians along with the hospital to seek the services they had already offered to the patient. Moreover, reimbursement of the physicians for their services is always determined by the rate of the flow of funds within the healthcare organization which would determine whether there is enough fund which would be used to compensate the physicians. Therefore, this essay offers discussion on how to prevent abuses and inefficiencies in the third-party payment, the flow of fund in the care organization together with the problems the consumers who are enrolled in the private insurance encounters.
The abuses and inefficiencies in the third-party payments can be prevented through various ways which include but not limited to engaging an experienced team of consultants to investigate on the compliance issues, using benchmarking to detect outliers, ensuring adequate resource compliance together with following the office of inspector general for compliance guidance. Benchmarking would assist in preventing abuses in the third-party payment system since it would capacitate the care providers to be proactive in evaluating billing data while comparing it to the similar providers locally and nationally thus this would assist in detecting and fraud and inefficiencies in the payment system. Therefore, after making a comparison and detecting any inefficiency in the payment system, the providers would take a step in protecting the system from further fraud and inefficiencies hence this would considerably contribute towards the protection of the third-party payment system. Similarly, engaging an experienced team of consultants would assist in preventing abuses and inefficiencies in the third-party payment system because the consultant would assist in offering consulting advice that may be beneficial in the development of compliance plan which would considerably help in reduces instances of fraud and any inefficiency in the payments system.
The flow of fund is the term commonly used in the healthcare setting in connection to the payment to reflect the agreed value within a transaction. It shows how the remuneration of the physicians flows from one department of the healthcare to another and finally to the physicians to compensate them for the services they offered to the patient population. Moreover, fund low encompasses any remuneration amidst partnering corporations. Examples of arrangements between partnering organizations that may acknowledged to be associated with the fund flow remuneration include a clinical partnership between the community hospital and the AMC, a health system partnership with a retailer, governmental body of community-based non-profit organization which support the health management of the population at the risk of contracting various health disorder within the society. Moreover, fund flow is habitually important to the healthcare organizations since it assists in defining and organizing individual agreements between the partnering parties through the aid of the fund’s flow plan. Besides, the funds flow plans usually controls the flow of monies in various forms of arrangements which include purchased services agreement, shared margins for new services, virtual joint venture along with the discrete joint operating agreement.
