UNIT 8: FUTURE DIRECTION FOR CLIENT EDUCATION

Module 8
KNOWING WHERE TO GO

1. OBJECTIVE

At the end of the chapter, the students are expected to:

1. Define a nurse educator in terms of his roles

2. Expound the functions of the health educator

3. Collaborate with other members of the health team in health education activities

2. LEARNING CONTENT

A. Greater Emphasis on wellness

B. Increased Third party Reimbursement

DISCUSSION

A. GREATER EMPHASIS ON WELLNESS – 

  Wellness- is an active process of becoming aware of and making choices towards a

healthy and fulfilling life.
 Christian Hahneman- develops Homeopathy, a system that uses natural substances
promote the body self-healing response.
  Sebastian Kneipp- promotes his Kneip Cure- combining hydrotherapy with
herbalism, exercise and nutrition.
 Concepts of wellness
 Holism- the aim is to be conscious of yourself as a whole and complete person,
living life as fully as possible.
 Self responsibility- a well person owns up to his or her responsibility for health and
happiness and does not allow others to take control over decisions he needs to make
for himself.
 Positive and proactive- wellness primarily positive perspectives and values by which
to live.

A. INCREASED THIRD PARTY REIMBURSEMENT

What is Reimbursement?
 Reimbursement is for services rendered to a person in which an entity other than
the receiver of the service is responsible for the payment.
 Third-party reimbursement for the cost of a subscriber’s health care is commonly
paid in full or in part by a health insurance plan, such as Blue Shield or Blue
Cross, Medicare, or Medicaid.
 Reimbursement is changing in healthcare. Even before elements of the Affordable
Care Act began to go into effect, a growing focus on value- based care versus
volume has led many healthcare organizations and providers to consider
accountable and patient-centered care models in which they assume a greater
share of risk.
 In this changing climate, revenue must be managed differently to ensure that the
value delivered to patients is paid for appropriately both in terms of accuracy and
timeliness.
What is Third Party Payer?
 A third-party payer is, to put it simply, anyone who pays for medical services other
than the patient himself. There are several types of third-party payers for healthcare
services in the U.S. The most commonly seen ones are private insurance companies,
like Blue Cross, and government insurance, like Medicare for the elderly or Medicaid
for those with lower incomes.
 All of these third-party payers will cover a portion of what the patient owes for his
medical services, and each type of payer has its own set of conditions that must be
met by the clinician or facility providing the services in order for it to get paid. These
sets of conditions used to be much simpler than they are now, but because the
presence of third-party payers has driven up costs of medical services, these
conditions are changing to allow care to become more cost-effective.

How Hospital are Reimbursed?

  Healthcare reimbursement describes the payment that your hospital, doctor,
diagnostic facility, or other healthcare providers receive for giving you a medical
service.
 Healthcare Reimbursement to Doctors and Hospitals. Healthcare providers are paid
by insurance or government payers through a system of reimbursement. ... The
amount that is billed is based on the service, and the agreed upon amount that
Medicare or your health insurer has contracted to pay for that particular service
Who are Third Party Payers in Health Care?
 A third-party payer is an entity that pays medical claims on behalf of the insured.
Examples of third-party payers include government agencies, insurance
companies, health maintenance organizations (HMOs), and employers.
Strategies for increasing Third Party Reimbursement
 Objective/Setting
 Design, Subject and Intervention
 Outcome Measures
 Results
 Applications/Conclusion
How do I get Medicare reimbursement?
 If you do need to file a Medicare claim, you will have to complete a “Patient's Request
for Medical Payment” form and send the completed form, along with an itemized bill
from your provider, to the Medicare contractor for your state. To look up your
state's Medicare contractor, visit CMS.gov or contact Medicare.

ACTIVITIES:

1. Do an Interview to an individual who has been hospitalized and ask about the hospitalization
expenses experience and trace the role of the Phil health Corp. and other health provider in the
Philippines and ask their opinion on the implementation of health system in the Philippines.