To regain public trust, healthcare providers should embrace transparency when establishing healthcare rates. There is always misunderstanding about the prices of health care services; in most situations, different healthcare facilities set distinct fees based on the type of medical insurance that the patient has, the location of service, and a variety of other considerations. The scenario described above makes it difficult for people to determine the real costs of a medical service. (2012) (Mannion & Braithwaite). The majority of people want price transparency in the healthcare system, so that consumers can quickly understand the costs of various medical operations and decide how much money they can spend before undergoing medical procedures. The transparency in the healthcare system is an important tool for gathering information regarding the medical prices; it enables the consumers to compare prices and come up with the informed decision on their medical plan. The price transparency also aids in lowering the prices of healthcare services as consumers will find the alternative ways to the ever rising prices.
Doctors, insurance companies, and the hospitals usually negotiate on the prices of the medical services. (Nowicki, 2015). In most cases, insurance companies usually tend to lower the prices with an aim of getting more customers. On the other hand, hospitals and doctors normally tend to raise prices in order to generate more profits. It is doctors who usually win in the long run as patients do not usually want to exclude their doctors in the medical plans. In the Medicare plans, it is the government that set prices for different medical procedures and they usually tend to lower it as much as possible in order to cover many people; in this case, there is always no negotiation between doctors and the government institutions. In the automobile industry, there is a sticker price that makes the automobile pricing understandable and rationale. The sticker gives the customers the base price for the automobiles and this facilitates the negotiation between the car buyers and sellers unlike in the health care where there is no base price. In the automobile industry, there is a competition based on prices, there is more transparency while setting the prices of goods and services.
Government regulation approach is appropriate when setting the healthcare prices because it is an inclusive method that will ensure that everyone is covered. By setting the prices that the medical providers should charge to the healthcare payers, the cost shifting can be eradicated, a situation that can lead to the general reduction in the cost of medical services. The government has the ability to pass health care laws that can allow patients to determine the base price for different medical procedures; in fact, the laws can be implemented immediately in the public hospitals. The intervention of the government policies can enable the insurance companies, doctors and hospitals to agree on the prices that will favor all the parties involved. The government approach should differ from the current methods in the Medicaid and the Medicare programs where they only state what should be paid and not what the medical service providers should charge. The government approach ignores the participation of the private insurers and shifts medical costs of under-compensation on them.
Developing a partnership with payers is one of the best ways of evaluating revenue cycle performance. It is essential to create a win-win situation in the medical system, a situation where every participant benefits from the service offered by the healthcare system. Developing the partnership with payers can improve negotiation when setting up medical prices, a situation that can enable the patients to effectively prepare for their medical plans. When the health care sector begin to introduce new payment models, a strong relationship with the payers is vital, the process enables the two parties to discuss the prospective issues and operate collaboratively in ensuring better healthcare delivery. Using technology to set the prices in the medical sector can improve the collaboration between the medical sectors and the patients. The patients are able to develop their own plans by planning for their own medical care.
The third step of the revenue cycle management involves determining the prior authorization for the required services. It is necessary to obtain the approval from the medical insurance companies before carrying out medical procedures. It is better to contact the insurance companies for the approval as this help in minimizing the costs of the medical procedures and maximizing the benefits in the case the information is authentic. ( Padget, 2016). Prior authorization involves reviewing the medications before establishing the medical plan. It helps in knowing if the medication is essential and appropriate for the situation. Lack of the prior authorization may lead to the high cost of medication or failure of the hospitals or doctors to cover it. The drugs that need prior authorization include drugs with dangerous side effects, drugs that are abused or misused, and the most expensive drugs. There are drugs that are covered under the pharmacy part of the insurance while others are put under the medical part of the insurance cover, a scenario that makes the document vital during the medication process.
References
Mannion, R., & Braithwaite, J. (2012). Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service. Internal medicine journal, 42(5), 569-574.
Nowicki, M. (2015). Introduction to the financial management of healthcare organizations.
Padget, D. L. (2016). Revenue Cycle Management. In Pathology Practice Management (pp. 53-78). Springer International Publishing.
