Fee For Care Research Paper

For instance, patients will receive urgent hospital care and then will not be able to pay back their bills. Another policy affecting provider reimbursements is the change from volume-based care to value-based care. For instance, the Centers of Medicare and Medicaid (CMS) have mandatory reporting guidelines that all healthcare providers have to participate in. These reports were based off volume of care (fee-for service) for the past 9 years, but due to the high costs in healthcare, the CMS is changing over to a valued based care (pay-for

Another issue for fee-for-service system is that the providers set the prices for services. Patients were free to seek any type of healthcare services that they thought they required, while providers set the costs for each service that was billed to indemnity insurance companies (Shi & Singh, 2015). Insurance companies had little control on the types of services that the patient received and prices billed for each service. The fee-for-service model encourages excessive and unwarranted procedures and offers no incentives to utilize economical services (Smith, 2010). While the patients enjoy the freedom of being able to seek out their own services, over-utilization of expensive services on unnecessary and highly technical services increased healthcare costs.

Revenue determination is an important tool for health care organizations because it allows for efficient management of payment systems. This paper will look at the different components that form the payment-determination bases of revenue determination. Moreover, the difference between specific and bundled service payments will be discussed. Lastly, the three ways health care providers control their revenue function will be highlighted.

Fee for service, as the name suggest is a method in which the healthcare provider is paid individually for each and every service provided. In this method the numbers of services determine the amount of reimbursement. This is where the healthcare providers misuse their authority and either provides more services than what is needed or just manipulate the number of services provided. There are specific

Any proposed policy to improve healthcare must address the current payment method, and the rising cost of healthcare. The common reimbursement method for healthcare services is the fee-for-service payment model. It requires providers to figure-out all incurred costs to render services for patients. Additionally, providers need to determine what is the insurer proposing to pay, which thought to reward quantity over quality. An alternative to this model is using a bundle

Fee for service indemnity plans are essentially health insurance plans in which the consumer may choose any provider or hospital that they want to use; however, these plans are typically more expensive than other plans (Mukherji & Fockler, 2014). The fee for service plans pay only for services rendered, typically using the CPT coding system (Reimbursement, 2016). The indemnity plans will require the provider to bill the insurance company for services rendered (Zuvekas & Cohen, 2016). Typically, the insurance company will pick up 80% of the patient’s bill and the patient is responsible for the other 20% (Zuvekas &

In this system, when payers pay billed charges, they pay according to a rate schedule, called a charge master, established by the provider. To a many extent, this reimbursement system places payers at the mercy of providers, especially in markets where competition is limited. In the very early days of health insurance, all payers reimbursed providers on the basis of charges. At prssent the trend is shifting toward other, less generous reimbursement methods, and the only payers expected to pay the full amount of charges are self-pay (private-pay)

Fee for service is a payment model where services are paid for separately, in health care, as opposed to bundeling them. It gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.

Fee -for-service is the most traditional form of reimbursement, pretty much like a restaurant bill, you pay for what you order. “A physician may be paid for each procedure performed, such as an office visit or the reading of a CT scan”. (Gapenski, 2013, p. 66) There are three primary fee-for-service payment methods: cost based, charged based, and prospective payment. In the fee-for-service reimbursement model the physician is to serve the patient to receive their payment.

cording to Batnitzky, Hayes and Vinall (2014), fee – for – service (FFS) “is the oldest form of reimbursement method, and in this system, healthcare professionals are paid for every service and test they provide” (p. 3.2). While the opposition would argue this form of reimbursement is the catalyst for medical professionals to “pad their wallets” for profits, FFS is would be equivalent to a professional in another field of work to be compensated for the services they render. FFS has remained within the medical pay system because, medical professionals should not be limited in using all resources at their disposal to ensure the correct diagnosis is achieved as, you cannot take a one size fits all approach when providing care to patients. Treatment

In a fee-for-service payment system, each specific service, procedure, intervention or piece of equipment provided is billed and paid for. A pro is the amount paid for services are usually negotiated between the insurers and the providers. Another pro is fee-for-service systems are reasonably flexible in that it can be used regardless of the location or place of service and the size of a physician’s practice. A con for a fee-for service system is it offers miniscule or no incentives to provide efficient care or prevent unnecessary care. An additional challenge is a fee-for-service system is constrained, to a certain extent, by coding guidelines and rules that explain what can and cannot be billed and paid for. Furthermore, payments are limited to one provider per interaction, therefore care management between multiple providers is extremely difficult.

Understanding the classification of healthcare services in terms of acute and long term care enable us to plan for services, to describe institutions, and to allocate funding and reimbursement. In the United States, healthcare services provided by health care providers (such as doctors and hospitals) are paid for by the following including, private insurance, Government insurance programs, people themselves (personal, out-of-pocket funds). Additionally, the government directly provides some health care in government hospitals and clinics staffed by government employees. Examples are the Veteran’s Health Administration and the Indian Health Service.

Under capitation, physicians are given incentive to consider the cost of treatment. Pure capitation pays a set fee per patient, regardless of their degree of infirmity, and gives physicians an incentive to avoid the most costly patients (Miller, 2009). Providers who work under such plans focus on preventive health care, as there is greater financial reward in prevention of illness than in treatment of the ill. Such plans avert providers from the use of expensive treatment options. The proponents of this method of payment especially insurance companies argue that when health care providers are not paid extra for additional office visits any associated medical expenses, they are likely to be more conservative with their treatment assessments

Under payment, an ideal healthcare system will have the challenge of delivering higher quality for lower costs. The system’s payment reform will involve a transition from fee-for-service to global from systems that are value-based important for the achievement of the overall healthcare goals. An ideal healthcare payment system will give a great deal of support to value-driven system of healthcare delivery (Kent, 2013). The fee-for-service payment system will be of great importance to the healthcare system as it will help control the costs of health care.

Most of the remainder is covered by government insurance programs like Medicare and Medicaid, and various state and local programs for the poor. Either way, health care providers must bill a patient’s insurer for the cost of services rendered. The billing process is generally considered to be one of the most inefficient and wasteful parts of our health care system, for the following reasons: