Discussion Question One 1 What strategies case management funded health plans Discussion Question Two 2 What major difference a service a reimbursement strategy Discussion Question Three 3 What opinion linking hospital reimbursement performance outcomes Cite literature

Length:  3 pages (1123 words) | Sources:  3  | Subject:  Business - Management | Type: Essay | Paper: #54944665 | Author:  

Note: Essay below may appear distorted but all corresponding word document files will contain proper formatting

Excerpt from Essay:

Service Strategy v. Reimbursement Strategy:

While there are various payers for particular healthcare services, only a small number of payment methods are utilized to reimburse providers. However, the existing payment methods in the healthcare system are mainly divided into two broad categories i.e. fee-for-service and pay-for-performance. These payment methods can be referred to as service or reimbursement strategies that have significant variations. The service or fee-for-service strategy is a payment method that is classified into cost-based, prospective-based, and charge-based methods. However, the main basis of a service strategy is that it's based on a charge-based payment method in which payers are billed charges. Through the billed charges, the payers pay for the care services based on a rate schedule or chargemaster developed by the care provider ("Paying for Health Services", n.d.).

In contrast, a reimbursement strategy is also known as pay for performance strategy, which is a payment method established by insurers to reimburse the provider for the costs incurred while providing services to the insured population. In most cases, the reimbursement strategy is based on the past since the insurer pays the provider depending on what has occurred in the past. This strategy is usually restricted to allowable costs i.e. costs that are directly associated with the provision of healthcare services.

The main difference between the two is that a service strategy is charge-based while a reimbursement strategy is cost-based. The service payment method is usually dependent on the rate schedule developed by provider, which implies that the payers are at the mercy of providers. Consequently, the service strategy is most commonly used in markets where competition among providers is limited. In contrast, a reimbursement strategy is cost-based, which guarantees that a provider's cost will be catered for by revenue.

Linking Hospital Reimbursement to Performance Outcomes:

Many insurers are currently developing reimbursement systems that clearly reward providers for accomplishing certain things. These systems are commonly known as pay for performance strategies since they are modified fee-for-service and capitation systems. The pay for performance strategy rewards providers for accomplishing specific treatment goals like patient satisfaction. Notably, insurers pay the care…[continue]



Cite this Essay

APA Citation

"Discussion Question One 1 What Strategies Case Management Funded Health Plans Discussion Question Two 2 What Major Difference A Service A Reimbursement Strategy Discussion Question Three 3 What Opinion Linking Hospital Reimbursement Performance Outcomes Cite Literature" (2013, February 06) Retrieved October 31, 2014, from http://www.paperdue.com/essay/discussion-question-one-1-what-strategies-85711

MLA Citation

"Discussion Question One 1 What Strategies Case Management Funded Health Plans Discussion Question Two 2 What Major Difference A Service A Reimbursement Strategy Discussion Question Three 3 What Opinion Linking Hospital Reimbursement Performance Outcomes Cite Literature" 06 February 2013. Web.31 October. 2014. <http://www.paperdue.com/essay/discussion-question-one-1-what-strategies-85711>

CHICAGO Citation

"Discussion Question One 1 What Strategies Case Management Funded Health Plans Discussion Question Two 2 What Major Difference A Service A Reimbursement Strategy Discussion Question Three 3 What Opinion Linking Hospital Reimbursement Performance Outcomes Cite Literature", 06 February 2013, Accessed.31 October. 2014, http://www.paperdue.com/essay/discussion-question-one-1-what-strategies-85711