Do Capitation Based Reimbursement Systems Underfund Healthcare Providers Discussion

These post replies need to be substantial and constructive in nature. They should add to the content of the post and evaluate/analyze that post answer. including one scholarly peer-reviewed reference. Minimum 100 words. Introduction With universal access and decreased costs, healthcare is both a calling for high quality medical care for patients and a business that must make enough money in order to cover expenditures. The term healthcare reimbursement is used to describe how commercial health insurance or government agencies pay for the services of health care providers (Riewpaiboon et al., 2011). Medical practitioners bill insurance companies or government agencies after patients have received treatment. The amount billed is based on an agreement with one or both of these organizations beforehand (usually Medicare). Medicare uses a common procedural terminology (CPT) code, whereas private businesses negotiate their own payment rates with physicians and health care providers. Pertinent billing has become more critical as the government’s focus on healthcare fraud and abuse and compliance has increased. In order to keep costs down while still providing high-quality care, healthcare providers are battling one another. There are several ways in which medical practices address these issues, including the use of current and emerging technologies (Mcclellan, 2011).

Best Fee reimbursement method for a Primary Care Facility and its Provider Primary Care Facility Capitation should always be used to pay for the services of diverse primary care physicians. But even though health care providers must be encouraged, the division of risks will produce motivations vital to lessen hospital use and expertise involved with trafficking in different patients in healthcare facilities (Tao et al., 2016). Alternatively, such doctors can be rewarded for their services on a discounted basis as an incentive to provide inclusive treatment, lowering the long-term growth of expenses. Daily payment of healthcare institutions like hospitals is standard practice with administered care plans. Hospitals must use this type of funding to entice physicians to place restrictions on patient admissions and the length of stay in the facility. So that the Physician-Hospital Organization PHO’s charge verification may be preserved over an extended period, daily reimbursement will be made (Chatterjee et al., 2013). The impact refund approach is quality, cost and access Quality: Health care providers are given incentives to enhance or attain patient satisfaction in order to restore the quality of the services they deliver (Mcclellan, 2011). Cost: Medical services and consultations are more expensive for the patient if the physician is reimbursed for their services or consultations.

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This varies depending on the service provider and the reimbursement methodology they employ. Similar to a two-sided model of value-based reimbursement, the provider is responsible for any costs incurred as a result of patient harm or mistreatment. As in capitation, a specific period is required for therapy, such as 15 days or a month (Green et al., 2001). Access: All patients and providers can benefit from refunds, regardless of their color, religion, community, or purchasing power (Mcclellan, 2011). Conclusion Public health is affected by socioeconomic and ethnic inequities. Reimbursement systems may encourage policy goals, including improving access to care, boosting the quality of treatment, and lowering costs by influencing how primary care services are financed. In addition to changing the reimbursement system, policymakers may demand that resources be allocated to poor populations as another method for addressing health care inequity (Tao et al., 2016). References Chatterjee, S., Levin, C., & Laxminarayan, R. (2013). Unit Cost of Medical Services at Different Hospitals in India. 8(7). https://doi.org/10.1371/journal.pone.0069728 Green, A., Ali, B., Naeem, A., & Vassall, A. (2001). Using costing as a district planning and management tool in. 16(2), 180–186. Mcclellan, M. (2011). Reforming Payments to Healthcare Providers : The Key to Slowing Healthcare Cost Growth While Improving Quality ? 25(2), 69–92. Riewpaiboon, A., Chatterjee, S., & Piyauthakit, P. (2011). Cost analysis for efficient management : diabetes treatment at a public district hospital in Thailand. 342– 349. https://doi.org/10.1111/j.2042-7174.2011.00131.x Tao, W., Agerholm, J., & Burström, B. (2016). The impact of reimbursement systems on equity in access and quality of primary care : A systematic literature review. BMC Health Services Research, October. https://doi.org/10.1186/s12913-016-1805-8 These post replies need to be substantial and constructive in nature.

They should add to the content of the post and evaluate/analyze that post answer. including one scholarly peer-reviewed reference. Minimum 100 words. Healthcare Reimbursement Reimbursement is another term for payment. The health insurance company or thirdparty administrator then pays the physician or facility for their claim based on their contract. Healthcare payment arrangements can be complicated, even if they appear to be simple. Reimbursement is important to a provider’s livelihood because providers are rarely paid in full for services performed to consumers under their various health insurance plans. (Valerius, 2020). The three primary processes by which an insurance company reimburses a provider or insured are fee-for-service, capitation, and salary. Every payment mechanism has advantages and disadvantages. Fee-for-service Under this arrangement, the provider will be compensated for each service provided to an insured person. For instance, if a patient visits a primary care physician for a check-up, a skin swab, and an MRI, the provider will be reimbursed for all three procedures.. (Gapenski & Reiter, 2015). Fee-for-Service Payment Models Capitation This payment method only applies to a covered life, regardless of the services given. As a result, instead of paying for each service performed, if patient A had a check-up, a skin swab, and an MRI, simply a predetermined fee would be paid. Under this payment scheme, patients must usually see a primary care physician before seeing a specialist. The goal of this strategy is to encourage service providers to limit the amount of unnecessary services they offer. (Berenson, Upadhyay, Delbanco, & Murray, 2016)One disadvantage of this approach is that, because of the emphasis on the medical problem at hand, preventive treatment may not get the attention it requires, potentially leading to chronic disorders. Furthermore, because this remuneration is based on the number of patients seen, physicians may see more patients than they would ordinarily in order to generate income, perhaps sacrificing quality by seeing patients for a shorter time. (Berenson, Upadhyay, Delbanco, & Murray, 2016). Salary This payment mechanism functions similarly to that of other employers.

The insurance company employs the provider, who is paid according to a specified wage and payment schedule. Regardless matter how many patients the provider saw, the pay would remain the same. Similar to standard reimbursement systems, private healthcare institutions in Saudi Arabia use insurance contracts to negotiate lower prices for their insured with facilities in their network. These contracts establish a fee-for-service basis. Patients who do not have health insurance will have to pay a higher price for these therapies. Insurance claims in Saudi Arabia are typically reimbursed within 60-120 days. In some facilities, a chargemaster, or fee schedule, is also used. Depending on the scale of the facility, Chargemasters may have 30030,000 separate services. (Bah et al., 2015). The effect that the method of reimbursement for claims has on quality, cost, and access Malignancies, diabetes, hypertension, and COPD are all chronic diseases and ailments that patients may spend a lot of money and effort addressing. Value-based care focuses on supporting patients in recovering from illnesses and injuries as quickly as possible, as well as preventing chronic disease in the first place.

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Do Capitation Based Reimbursement Systems Underfund Healthcare Providers Discussion