Fee For Service Utilization And Reimbursement

1361 Words Jul 13th, 2015 6 Pages
Fee for Service Utilization and Reimbursement
The business goals of modern healthcare include the need to increase patient safety and satisfaction, to eliminate fraud, waste, and abuse, and to maintain employee satisfaction in order to control costs and increase profitability. However, in reviewing the history of healthcare reimbursement, this was not always the case and at a point in time existed where the cost of healthcare was escalating exponentially due to abuses in the way providers were allowed to utilize and bill for services. Due to this, the changes in how healthcare services are reimbursed changed dramatically over the past several decades with those changes designed to create savings for insurers and those entities paying health care premiums.
Fee for Service Reimbursement
A variety of health plans have existed in one form or another for hundreds of years; history is able to show that medieval guilds collected fees from guild members with a portion of those funds going towards care for the sick. The beginning of modern insurance as we know it today can be traced back to regional cooperatives, as well as the inception of the Baylor plan, which was the impetus for the creation of Blue Cross.
The creation of the various insurance plans provided health care practitioners with the ability to control income to increase profitability. Many of these plans were pre-paid plans until 1932 when the American Medical Association (AMA) “adopted a strong position…
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