Here is the synopsis of our sample research paper on Health Care Payment Systems: PPS. Have the paper e-mailed to you 24/7/365.
Essay / Research Paper Abstract
A 6 page paper examining the nature of the PPS health care payment system. Within this system, Medicare essentially sets fee parameters throughout the country. It can be a challenge for care providers to operate within the constraints that Medicare’s accepted fee levels can impose, but care providers have little choice but to operate within the restraints that Medicare requires because of Medicare’s effect on private insurers. The end result is that prices increase for reasons not associated with market conditions at all, and greater numbers of Americans join the ranks of the uninsured as no one – individuals or small businesses – can keep up with price increases in insurance. Bibliography lists 4 sources.
Page Count:
6 pages (~225 words per page)
File: CC6_KShlthCarMgdPay.rtf
Buy This Term Paper »
Unformatted sample text from the term paper:
After the failure of the 100th attempt to create a light bulb that could work for more than only a few seconds, someone suggested to Thomas Edison that it was
a nice idea, but that he should abandon the effort as being unworkable. Edison replied that he had not failed, but had only discovered 100 ways that did not
work. It seems we have the same situation in managed care payment systems. System Overview Hoffman, Klees and Curtis (2003) publish a
biannual overview of the Medicare and Medicaid programs in which they include a description of the current reimbursement system, the prospective payment system (PPS). PPS replaced the reasonable cost
basis of reimbursement to hospitals in 1983; nursing homes are reimbursed under a separate PPS. Payments for inpatient rehabilitation, psychiatric, and home health care are currently reimbursed on a
reasonable cost basis, but PPSs are expected to be implemented in the near future (Hoffman, Klees and Curtis, 2003; p. S1). When a
health care provider (hospital, physician, nurse practitioner or other provider) accepts assignment, s/he is agreeing to accept as payment in full the Medicare rate for coded procedures and diagnoses.
The provider may not charge either the patient or supplementary insurer an additional amount. "If the provider does not take assignment, the beneficiary will be charged for the excess
(which may be paid by medigap insurance)" (Hoffman, Klees and Curtis, 2003; p. S1). Payments are made on the basis of a specific
predetermined amount based on each patients "diagnosis-related group (DRG) classification" (Hoffman, Klees and Curtis, 2003; p. S1) that guides the rate of payments that the provider receives. Placing the
...