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Essay / Research Paper Abstract
A 3 page paper comparing current forms of reimbursement. Several types of reimbursement systems have come into being as healthcare continues to evolve. Three are the Prospective Payment System, Fee for Service and Capitation. Every payment system carries some form of risk. It is left to the provider to determine which form best fits the provider's area of service. Bibliography lists 4 sources.
Page Count:
3 pages (~225 words per page)
File: CC6_KShlthCrPymtPlan.rtf
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Unformatted sample text from the term paper:
systems have come into being as healthcare continues to evolve. Three are the Prospective Payment System, Fee for Service and Capitation. Prospective Payment System
Under the Prospective Payment System (PPS), payment is based on the patients diagnosis-related group (DRG), which determines how much the provider will receive for that patient regardless of
what services the patient receives. "In some cases the payment received is less than the hospitals actual cost; in other cases it is greater than actual cost. The hospital
absorbs any loss or retains the profit" (Younis, 2004; p. 23). This is the payment system currently used by Medicare. Hospitals "have an incentive to discharge Medicare patients
as soon as medically possible in order to maximize the difference between resources used and the Medicare payment received" (Younis, 2004; p. 23).
Risk. Providers risk needing to provide services costing more than allowed according to DRG classification. Providers must ensure that they place the patient in all applicable DRG categories
to maximize revenues. Effect of Service Mix and Utilization Rates. Providers are affected less by these factors under PPS, because payment is
based on the services likely to be needed. Break-even Likelihood. This approach should be attractive to providers. They should at least
break even if they operate efficiently and do not provide unnecessary services (Corrigan and Ryan, 2004). Fee for Service The fee for service
approach enables providers to be paid for each service provided for payment plans members. The fee paid will be discounted, of course, but the provider can expect to be
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