Fluent Essays

DUE IN 48 HOURS ATTACHED · Ask at least one question in response to an original peer post that you would like the author to explore further.  Respond to at least two of your classmates’  TIFFANY’S POST: Payment Differences The difference in payment for same services within the healthcare field has been a long-standing issue for patients. People in the United States routinely cite health care and health care costs as top concerns (Kennedy et al., 2020). As a result of this in recent years that have been several actions taken to try to streamline cost and pricing across the board for all medical services. However, when examining payment rates and why there is a vast difference for the same service depending on the payer sources, a common reason is that when it comes to traditional insurance like Blue Cross/ Blue Shield, they normally have to negotiate rates for each service. The rate that is settled upon is not always going to be the same with each traditional insurance company. Larger insurance companies tend to negotiate better rates then smaller insurance company. This in turn normally results in lesser amounts out of pocket for the patient. Now this situation is different when you look at Medicare or Medicaid for example because instead of negotiating, they have a set payment rate that they pay for a specific service, and they don’t negotiate that amount with the provider. It is well documented that the prices paid by commercial insurers are, on average, higher than the prices paid by Medicare for the same services (Kennedy et al., 2020). As mentioned by Kennedy et al (2020) for CPT code 99213 in 2017 a commercial insurer would have paid $93 whereas Medicare would have paid $74.,. Another factor in the difference of payment is the location of where the procedure or service is completed.  For instance, for the same procedure it will normally be paid at a higher amount if it is done at some type of facility versus having that same procedure done at a doctor’s office. Another reason for the difference in payment is that with some facilities and provider they sometimes offer a better rate to a patient that is paying out of pocket versus an individual that is going through some form of insurance.   Kennedy, K., Johnson, B., Kurowski, D., Biniek, J., Bloschichak, A., Martin, K., & Clayton, E. (2020, August 13). Comparing Commercial and Medicare Professional Service Prices. Health Care Cost Insitute. https://healthcostinstitute.org/hcci-originals/hcci-research.   CARMEN’S POST: Payment Differences Payment differences are important in budgeting because they allow individuals to pay for services render. Similar to our personal lives we are able to pay with credit cards, cash, snap benefits and much more. There is a vast difference in payment for the same services by various payer sources in mental health services because of the need. There are some individuals that require assistance due to low income. In which they might qualify for Medicaid benefits, the elderly is able to benefit for Medicare with incentives that benefit seniors such as medication being dropped off at home. According to Balch et. al (1977) a study conducted with cmhc found that insurances utilized age, sex, and social class are factors to decide on fees and assistance. Overall, in Balch et. al (1997) study found that sources of payment were significantly related to number of client contacts and length of stay (p.504). This practice impacts the profession and budgeting because it is essential to know your clientele. Understanding the need to provide not only support but services that would benefit the client and feasible for them to pay. When individuals are not able to pay for services out of pocket there is possibility for Medicaid, if elderly they can receive Medicare, however if these services are not available for them the option for sliding scale based on income and co-payments come into play so that clients can receive services they need. The overall reason for payment differences is that it allows individuals to obtain services they need at a fee they can afford. In turn individuals would be more open to engage in service/ treatment for a longer period of time.  According to Dayton (2016) sliding scales are based on client’s income, family size and ability to pay to make services for individuals more affordable. The payment differences are essential in mental health as they allow individuals to get the treatment they need through various payment options. References  Balch, P., & And Others. (1977). Fees and Therapy: Relation of Source of Payment to Course of Therapy at a Community Mental Health Center. Journal of Consulting and Clinical Psychology, 45(3). Dayton, J. (2016, August 11). BRIEF: Group offers mental health services on sliding pay scale. Janesville Gazette, The (WI). Dropkin, M., Halpin, J., & LaTouche, B. (2007).  The budget-building book for nonprofits  (2nd ed.). Jossey-Bass · Ask at least one question in response to an original peer post that you would like the author to explore further. Respond to at least two of your classmates’  LESLEY’S POST: Discuss how you would continue to justify a budget loss to a board of directors or grant funding agency. Just by seeing or hearing the word loss, one immediately jumps to, it’s gone, and lost forever, however in the world of budgeting, a loss is not always a bad word. Obviously, no organization wants to lose, but there are times when a budget may show a loss in one department yet overall, there is no loss. For example, one can consider that office supplies from a budgetary standpoint are a loss, those supplies do not bring in revenue, so every dollar spent is not have the potential to earn another dollar. Yet, you could look from the perspective that every dollar spent is a dollar invested. The phone is used to connect with clients for appointments, the internet is used for research, billing, patients, communications, etc so not all expenses have an off-setting income but each as important as the next and overall, has validity as an expense to contribute to the overall mission. This is exactly how I would continue to justify a “budget loss” to a board of directors or grant funding agency, there is no actual loss, only the investment in the organization's mission. Dropkin, Halpin, and LaTouche, wrote, “…What you are going to send the money on…” which can be the same explanation for a loss (p. 65, 2007). What negotiation or conflict resolution strategy would you recommend if the board or agency does not accept the initial justification? Should the board or agency not accept the preliminary budget justifications, I would employ an assertive collaborative strategy in which both the board and organization can find mutual ground and understanding. From the organization’s perspective, there must be an understanding that the board may not see the view from the ground, from the mission, but more so from a business on paper projection. Whereas, the organizations know the ins and outs of the operations and their importance. I would possibly even go as far as to invite the board or agency to see firsthand the mission and organization's accomplishments, maybe invite them to join a fundraiser or activity hosted by the organization to show firsthand the good that is being done.   Reference Dropkin, M., Halpin, J., & LaTouche, B. (2007).  The budget-building book for nonprofits  (2nd ed.). Jossey-Bass.  JO’S PSOT: Justifying Budget Loss To justify any loss you have to understand what the problem is with the program. Through a thorough assessment of the program and what is expected of the program. . A loss can be interpreted as finding a better way of meeting the goals of the grant and organization.  When working with the community sometimes the changes could need to be how the program is marketed. When addressing the board or grant funding agency the need for the program needs to be justified. Crompton (2009) suggests four strategies for repositioning 1) restructuring the existing service, 2) aligning with other organizations who share the desired position, 3) psychological repositioning by attempting to change the stakeholder's beliefs about the outcome, 4) alter stakeholders' beliefs about what an agency's competitors are doing. This form of collaboration provides a hands-on level of observation to see what is working at a similar organization. Sometimes things need to be seen in action.   All options should be looked at and addressed to find a solution to the problem. Ensure that the organization shares the same vision as the board and funding sources. In some instances, a consultant may be needed in order to enhance or revamp the program and to see what is missing in the program. Consultants can bring a fresh look at a program and from their past experiences provide suitable changes to that program.     References Crompton, J. (2009). Strategies for implementing repositioning of leisure services. Managing Leisure, 14(2), 87–111. Dropkin, M., Halpin, J., & LaTouche, B. (2007). The budget-building book for nonprofits (2nd ed.). San Francisco, CA: Jossey-Bass. https://www.conovercompany.com/conflict-resolution-8-steps-for-resolving-conflicts/ (Links to an external site.) (Links to an external site.) 8 Steps for Conflict Resolution