Factors Affecting Hospital Reimbursements

Abstract

In conclusion, reimbursements are essential in hospital settings, and they influence the levels of financial assistance to health institutions. The factors affecting payments include readmission, types of insurance policies held by patients, the medical conditions and past medical history of patients. The length of treatment is another factor that affects reimbursement, and it determines how the health facilities attend to patients and the expertise of physicians. Hospital-acquired conditions also affect reimbursement patterns and cause penalties to hospitals.Professional fees affect reimbursements by affecting the cost of medical services for patients. When physicians and other healthcare providers provide their services to patients, there are significant variations in the fees they charge for their services. These variations affect the revenues obtained by hospitals and therefore have an impact on hospital reimbursements. The facility fees also affect reimbursements by altering the cost of service delivery in hospitals. Facility fees deal with operational costs such as those involved in purchasing stationery and doing other practices [1]. In prospective payment systems, DRG weight is an essential consideration in calculating the extent of reimbursement, and it is the government, which comes up with such rates.

Extended Length of Hospital Stay for Surgical and Medical Patients – Insights from Hospital and Psychosocial Predictors

“…Extended Length of Hospital Stay (ELOHS), which is described as patients overstaying the high trim point (3*average LOS) for a particular Diagnosis Related Group (DRG), has also contributed negatively to the hospital image because it has been used as one of the quality indicators of good hospital care [7]. Imperatively, affecting hospitals' insurance reimbursement because of the penalties imposed on them for poor patient care [8]. Numerous studies have looked at ELOHS for different disease conditions to identify the factors responsible for patients overstaying the time they are expected to stay in hospital.…”