In accounting, the phrase flow of funds refers to an order in which an organization’s revenue is channeled or allocated to multifarious units, departments, or agencies. The term funds have two major perspectives or meanings. It can be recognized as the accessibility of net working capital and cash available. It is the responsibility of financial managers to ensure that they have real-time control over the flow of funds. Finance or funds can be likened to the lifeblood of an organization. The flow of funds, therefore, determines the health of organizations. This aspect covers all sorts of organizations inclusive of schools, universities, care organizations, companies, firms, and colleges. Therefore, this essay seeks to explain the flow of funds within an organization including private pay and third-party reimbursement. It will further provide an explanation of how to prevent abuses and inefficiencies in third-party payments, a definition of the flow of funds in the Care Organization, challenges faced by consumers who are enrolled in private insurance, and the methods that can be used to empower the consumer.
Inappropriate payments and inefficiencies in third-party payments or insurance organizations take place due to injury, errors, or fraud. The impact of this issue is so large such that health organization has no other option except to prioritize it. Traditional approaches that were used to detect and prevent health care abuse and fraud are efficient and time-consuming. Nowadays, a combination of statistical knowledge and automated methods has led to innovation and use of Knowledge Discovery from Databases (KDD). Data mining can offer exclusive assistance to third-party payers to obtain any relevant information from many claims (Feldman, 2001). The revolution of computers and use of electronic health records have led to the emergence of new opportunities that are better in detecting abuse and fraud. Ideally, data mining methods go hand in hand with integrated information technology (IT) software packages.
There a number of healthcare anti-fraud partnerships such as Healthcare Fraud Prevention Partnership (HCFP), Centers for Medicare and Medicaid Services (CMS), the office of the inspector general, general services administration and health care fraud prevention, and enforcement action team (HEAT). The OIG has a responsibility of protecting the integrity of the health care system including its benefits. The OIG works with a network of investigators, inspectors, and auditors (Feldman, 2001). Government agencies are capacitated to prevent fraud and abuse by ascertaining integrity, reducing healthcare and related costs, improving the quality of health care, and recouping taxpayer funds. To operate, entities, law enforcement agencies, and individuals ought to work with CMS to detect and prevent fraud.
To ascertain a successful partnership agreement, it is advisable for the healthcare organization to implement a framework that ascertains an effective flow of funds. In a situation where American health policymakers have to make a decision, issues related to finances, care, and delivery should be adequately discussed (Kodner & Spreeuwenberg, 2002). It is evident that most health care organizations have to finance their projects. Funds usually flow from the households to insurance firms. American citizens typically function as the pumping station to ensure efficient flow of funds. There are two ways in which flow of funds occur namely; extraction from private households and disbursement facilitated by insurance funds. Fueling flow of funds involves three routes. Insurance pools, taxation, and private business firms. Organizations tend to maximize the reimbursement volume with the aim of changing the flow of funds. Financial models are, therefore, designed to stimulate cost containment and population health.
Affordability of an insurance cover has remained constant in the U.S. Even though there have been efforts to lower insurance premiums through subsidies, a substantial number of consumers still cannot afford to get a cover from the marketplace. According to research, a quarter of the adult population who has taken private insurance has unaffordable coverage through deductibles, out-of-pocket costs, and premium coverage (Parragh, & Okrent, 2015). The presence of financial challenges has affected the nature of protection as individuals find it riskier to keep on paying dividends.
Consumers have grown weary of many health insurance firms. The employer-based model makes it impossible for the consumer to have control over the payment plans of the policy, and health insurers are the key contributors to this arrangement (Nickitas, Middaugh, & Aries, 2016). Besides, the policies associated with the Affordable Care Act are to be blamed for the challenges experienced by consumers (Katz, 2014). Private payers normally experienced significant financial losses during the process of health insurance exchanges inclusive of other processes in the ACA marketplace.
It is unfortunate that many individuals do not even understand their covers gained through marketplaces. They have little to no information in regard to cost-sharing requirements and the scope of the protection. This can be attributed to insufficient or weak health literacy. Acquisition of private insurance, which is founded on cost-sharing and premiums, still pose significant challenges to many consumers. Due to financial insecurities, many consumers end up having difficulties in sustaining premium payments (Parragh & Okrent, 2015). The forces that influence healthcare systems have driven consumer trends. Conducting of reforms, regulations, plan options, and new pricing have enabled many to acquire insurance covers. However, the same insurance industry is currently becoming more complex courtesy of reforms and policies.
A plethora of blogs, wikis, applications, and websites exist to provide comprehensive information to consumers. Such platforms attempt to avail relevant information to the consumers hence reducing the level of health insecurities. Hospitals and providers are now interested on assisting consumers in learning relevant aspects such as self-management, when to seek or not to seek help, and how to ensure the doctor has comprehensive information concerning a particular patient. Innovative platforms have been designed to make health education interesting.
The modern consumer is using different mobile applications and devices to manage their financial, health, and travel life at large. Similarly, there has been an influx of health-related tools and applications for consumers to choose from in the marketplace. With such applications, a consumer can track physical activity levels, sleep patterns, blood pressure and glucose, and steps (Nickitas, Middaugh, & Aries, 2016). A wirelessly transmitted data ensures that the patient’s health plan is kept up to date.
Consumers are been empowered by improving accessibility and easiness of the use of healthcare technology. Telehealth and devices can enable a consumer to stay proactive on matters related to personal health.
Feldman, R. (2001). An economic explanation for fraud and abuse in public medical care programs. The Journal of Legal Studies, 30(S2), 569-577.
Katz, M. (2014). Healthcare made easy: Answers to all of your healthcare questions under the Affordable Care Act. Fairfield, OH: Adams Media ISBN: 9781440580208
Kodner, D. L., & Spreeuwenberg, C. (2002). Integrated care: meaning, logic, applications, and implications–a discussion paper. International journal of integrated care, 2(4).
Nickitas, D. M., Middaugh, D. J., & Aries, N. (2016). Policy and politics for nurses and other health professions (2nd ed.): Advocacy and action. Sudbury, MA: Jones and Bartlett Publishers. 978-1284053296 (Amazon) 9781284089639 (VitalSource)
Parragh, Z. A., & Okrent, D. (2015). Health literacy and health insurance literacy: Do consumers know what they are buying. Alliance for Health Reform, Jan.
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