The multi-tiered healthcare system in the U.S. is a slow and ponderous process, but one that’s essential for the financial stability of practices and to ease the pain and suffering of patients. Nitin Chhoda explains health insurance and its relations to our current economy.
Healthcare is a complicated and convoluted process in the U.S. that involves patients, practitioners, health insurance providers and a multitude of clearinghouses established specifically for processing, verifying and paying claims.
Due to the many facets of the industry, it can leave even insured patients with insufficient health insurance coverage or none when they need it most, while clinicians are buried in a mountain of paperwork and rejected claims.
Healthcare in the 21st Century
Healthcare was a reactive system focused on treating ailments and illnesses as they appeared. The beginning of the 21st century saw a shift in the thinking of health insurance company executives toward preventative measures and ways for clients to avoid becoming ill or developing conditions such as diabetes and heart disease.
When the Affordable Health Care Act is fully implemented, millions of previously uninsured individuals will have access to a core group of services through health insurance policies obtained through their employment or management insurance exchange.
Health insurance providers are beginning to change their procedures by forcing patients to shoulder more of the cost burden and setting limitations on costs and treatments.
The result is that many clients that have health insurance are no better off than those without.
Due to these insurance practices, physical therapy management must develop and implement strategic plans to contract with the best paying providers and examine client health insurance coverage closely before beginning a treatment.
To remain solvent, clinicians will be required to make hard decisions about the patients they treat, the health insurance they accept and the providers with which they contract.
The technology embodied in an electronic medical record (EMR) system is a clinician’s best friend for verifying health insurance, providing enhanced documentation and submitting reimbursement claims.