With the unexpected spur of a pandemic that has led to many changes in the lives of workers from various fields of expertise, healthcare has become a hot topic for conversations between employers and employees. So, it is about time to know how to handle these talks more effectively and get arrangements that are beneficial to both sides.
What are Healthcare Reimbursement Arrangements?
To put it simply, Healthcare Reimbursement Arrangements (HRA), or what others may refer to as either healthcare reimbursement plans or healthcare reimbursement agreements, are arrangements wherein an employer agrees to cover their employees’ medical expenses up to a certain amount.
How does it work?
After a treatment, the medical provider bills the party responsible for the cost, based on the patient’s HRA. This may be by a public payer (ie the government) or a private payer such as the patient’s employer.
The healthcare providers, then, process the claims. They record the diagnostics and treatment details in the Electronic Health Record (EHR) to document the treatment. Afterwards, certified healthcare providers apply medical codes to give specific and accurate descriptions of the treatments received. These codes are important as they provide a standard procedure in the process of the reimbursement of the service received. There are agencies like Alpha II that offer software that aid in ensuring that claims are processed well from the recording of the narrative to the clinical coding and even the billing edits. As technological know-how is important in the processing of these reimbursement claims, getting Alpha II software solutions can help ensure the quality of the claims and limit revenue loss due to incorrect documentation and coding.
Once everything has been clearly and accurately documented, the providers will submit the claims to the payer or a clearinghouse. Clearinghouses are entities that ensure the payment claims do not have any errors before being forwarded to the respective payers.
What are the benefits of healthcare reimbursements?
HRAs benefit employers and employees alike as this type of arrangement:
- gives small businesses the ability to provide health plans to their employees
- allows unused funds to be carried over to the following year
- provides employers with tax deductible claims
- allows both parties to foresee health care benefits
- the employee does not need to be enrolled in another health plan to take advantage of the benefits
- saves both parties money
What are the disadvantages?
Although quite beneficial to various types of employers and employees, the HRA also has its cons. Some employers do not offer this kind of arrangement as there are quite a bit of provisions and rules in place. Due to this, they are not completely knowledgeable of the process and their eligibility for it. Therefore, they do not bother with it. There are also some healthcare providers who avoid reimbursements like the plague due to the process. They find it lengthy and tedious.
But these disadvantages are easily remedied by third-party agencies. A third-party administrator can answer all the questions an employer may have. As for the processing of claims, to efficiently do this with minimal effort, software and services offered by Alpha II can be utilized. Agencies can easily supply interested companies, regardless of the size or type of the business, with the knowledge and ability to provide healthcare to their workers especially when accidents, the spread of diseases, and the development of illness are inevitable.