Medical Reimbursement Methodologies

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1. You're the new director of a hospital health information management department. The chief financial officer has hired you for your expertise in health care reimbursement and needs to know how your department can help with reimbursement. List the most important functions of health information management.


The Blue Cross and Blue Shield Plans were really the blue prints from modern health insurance. That which started as a hospital plan for public school teachers at the Baylor University Hospital, became the model for Blue Cross Plans around the US. Essentially, these were prepaid plans for hospital services under a contractual agreement. Blue Cross dates back to 1933 where with support from American Hospital Association, this started as a nonprofit plan that covered only hospital charges. By 1946, this plan spread across 43 states and starting from 9% in 1940, in 1950, it covered about 57% of the population. In order to avoid conflict with the in-clinic private practice, to start with this was hospital oriented. This was endorsed by AMA, and later a new plan evolved in 1939, which was known as Blue Shield, and this evolved through development of active service plans. This was sign of commitment to private health insurance as the means to spread the financial risk of sickness without fear of threatening personal interests of the physician. These plans were literally responses to challenge thrown by national health insurance. In due course of time, they started working together to provide both hospital and physician coverage. Now, these plans jointly provide a comprehensive care through either joint corporations or close working relationships. ...
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