Reimbursement Options Discussion
Develop a review of the various reimbursement options that a large primary care office would have for the charges associated with a new patient consult.
Reimbursement for services rendered by providers (physicians, physician assistants, and other providers) is generally made under one of two payment types: fee-for-service or episode of care reimbursement. Fee-for-service methodology is based on the premises that providers receive payment for each service rendered and is based on a set amount or price for each service. Included in this methodology are self-pay payments, retrospective payments, and managed care contracts.
Under the episode of care methodology, providers receive one lump sum for all services provided related to a given condition or disease. Understanding each method of payment, its benefits and drawbacks, as well as its impact on cost control and resource utilization is important for those working in the health industry, as reimbursement impacts many decisions made about budgets, forecasts, strategy, and service line capacities.
In this assessment, you will demonstrate your understanding of various reimbursement options within the context of a new patient consult. For this assessment, assume the role of a reimbursement specialist for a large primary care office. While you are aware that your providers are reimbursed in several different ways, the providers are uncertain as to what each reimbursement type means for the practice in terms of collections. They have requested that you outline the different reimbursement options to which the practice is subject for the providers in the group.
DEMONSTRATION OF PROFICIENCY
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Compare current trends and traditional methods of payment in the health care industry.
Explain payment options for uninsured patients, including how the patient would qualify for each option.
Competency 2: Assess health care reimbursement.