Healthcare Management Capstone- Individual Project 2

.docx

School

Colorado Technical University *

*We aren’t endorsed by this school

Course

HCM612-160

Subject

History

Date

Feb 20, 2024

Type

docx

Pages

Uploaded by CaptainCrownHorse33

1 Reimbursement Methodologies Khadijah C. Rojas Colorado Technical University HSS491 Healthcare Management Capstone Prof. Teresa Thomas Date: 11/6/2022 HSS491 061222/ttb

2 Reimbursement Methodologies Medical expense reimbursement has been paid for using a variety of payment mechanisms, each with varying levels of effectiveness. It is crucial that the systems that are developed employing each of these mechanisms, separately or in combination, provide accommodations that are appropriate for the amount, complexity, and caliber of care provided. Utilizing patient data to track doctor conduct, patient reaction, and healthcare organization operations can assist enhance the standard of medical care while also improving the accuracy and effectiveness of payment procedures. The capitation technique, fee-for-service method, and bundled payment method are three popular reimbursement strategies used by healthcare organizations and providers. Reimbursement Methods Under the Capitation reimbursement method, healthcare professionals are paid a set amount per patient (Nelson, 2021) . The providers that are compensated using the capitation mechanism receive regular monthly payments in addition to regular patient allocations. Whether or not the patient sessions are used is a factor in the payout. Because the suppliers know the monthly fee for each enrollee, they are unable to demand additional payments if the price rises over the payment. Due to the reimbursement system, doctors are more inclined to advise patients to take preventative measures and pay close attention to reducing the number of trips they could require. Under the Fee-for service method, medical health care organizations, as well as providers, are compensated for each service and test they perform to a patient. This means that every test and every procedure is paid for by the healthcare organizations and providers. Contrary to medical professionals and organizations covered by capitation, under payment for service, there is no incentive to promote preventative measures or avoid expensive procedures HSS491 061222/ttb

3 and testing. Under the bundled payment, the healthcare providers are compensated for the specific health care episodes, such as inpatient hospital stays (LaPointe, 2016) . This reimbursement approach encourages effectiveness and high standards of treatment and service. This is so that you can pay for the entire treatment episode with the predetermined amount of money. According to this method, the healthcare professionals are compensated for their care and attention of the patient's condition throughout the entire course of treatment. This covers the tools of support, the methods, the evaluations, the medications, and the equipment. Method used for Facility In a primary care facility, the best reimbursement method to use is the Fee-for service payment method. This method is known to be the most traditional method used throughout the healthcare system. Under this model, providers are reimbursed based on how many services and procedures provided to their patients. In primary care facilities, many services are provided. This includes physicals, point of care testing, patient consultations, and any in clinic procedures provided. Pros and Cons Before the value-based care movement, the most common type of health insurance was the fee-for-service plan (Rice, 2021). For those who can afford it, fee-for-service insurance, also referred to as indemnity plans, allows total independence and flexibility. With little interference from the insurance provider, patients are free to select the doctors and hospitals of their choice under fee-for-service plans. Due to the possibility of customers being required to pay for their medical treatments up front and submit receipts for reimbursement, fee-for-service health plans typically involve out-of-pocket expenses. Patients receive excellent care, and the provider can make the right suggestions. Physicians can be flexible to provide their patients with accurate HSS491 061222/ttb

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help