As the healthcare field continues to change and evolve, so too does the financial aspects of this dynamic sector. Years ago, patients would pay out-of-pocket for healthcare often through some form of barter system. This then evolved as companies began to offer individual insurance where a patient would pay a premium for a limited policy, and eventually this became perks employers would offer to employees to offset the cost of premiums with no pre-existing conditional requirements.  The government recognizing a weakness in the system, and intervened to offer a safety net for the poor and children. Charitable organizations also noticed a need, and many opened their own hospitals and clinics or provided funds to help those in need.

All of these various revenue sources provided advantages and disadvantages for both the healthcare provider/organization as well as for the patient. When looking at advantages, for a healthcare organization, having various revenue streams provides many different options for attracting financial support. This is important as an organization must be able to provide for the community it serves, and by only having one revenue stream will severely limit that organization (Community health, 2012). For example, if an organization only depends on Medicaid/Medicare revenue for financial support and the government decides to decrease reimbursements, the organization could face short falls in its budget. Also, multiple revenue streams allow for better planning for short-term and long-term projects.

On the other hand, an organization facing these budget deficits with other revenue streams, such as charitable donations and/or insurance reimbursements would be in a better position to offset this obstacle and keep the organization solvent. However, with various revenue streams, there are also disadvantages. Medicaid/Medicare have specific quality and safety metrics which must be reported and met on a regular basis or that organization will run the risk of losing their approval to be reimbursed for services (Barbee, 2016). Also, many third party payers, such as private insurance companies, have their own requirement for reimbursement that must be met in order to receive revenue that do not always match that required for Medicaid/Medicare (Buppert, 2011). Keeping all the requirements in check, and managing all that data in the correct form and in a secure format will be paramount. Also, there must be consideration for situations where an insurer will only pay a portion of the bill, requiring the organization to then recognize this and seek the rest of the payment from the patient or a charity if possible.

References:

Barbee, A. (2016). When access isn’t equal: Enforcing the Medicaid equal access provision in Medicaid managed care contracts. Public Contract Law

           Journal, 45(2), 383-402.

Buppert, C. (2011). How to avoid reimbursement denials. The Journal for Nurse Practitioners, 7(4), 321-322. 

Community health; family HealthCare center selects RTLS solution from intelligent InSites to improve efficiency and care. (2012). Computers,

           Networks & Communications, 278. Retrieved from https://proxy.cecybrary.com/login?url=https://search.proquest.com/docview/922546591?

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