Chapter 9 Reimbursement Flashcards
Charges set on what market will pay or what charge-based patients/insurers pay
Competition-Driven Charging
Ensures that the charge set for a specific item results in maximizing reimbursement
Charging analysis
Ensures healthcare organizations are charging for items that third-party payers recognize as legitimate charges
Chargemaster enrichment
Compares what patients receive, as documented by medical records, to what patients are billed, as documented in patient bills.
Ensures healthcare organizations are not losing charges within the organization
Charge capture assessment
readily available information on the price of healthcare services that, together with other information, helps define the value of those services and enables patients and other care purchasers to identify, compare, and choose providers that offer the desired level of value
Pricing transparency
Departments that know the cost of their products use which method of setting charges
Surcharge Method
Method of setting charges low in the short-term to gain market share
Predatory pricing
Method of setting charges low in the long-term by changing products or services
Slash pricing
Method of setting charges relative to market leader
Follower pricing
Phaseout pricing
Method of setting charges high to eliminate poor quality
Preemptive pricing
Practice of setting charges low to discourage new entrants to the market
Which method of reimbursement is the most favorable for physicians?
Charges
Departments that use the hourly rate method of setting charges
(2 parts)
charge per hour or modality of time for services.
include physical therapy and radiology.
Practice of setting charges at different levels for different customers
Slide-down pricing
Effort to pay providers for quality rather than quantity
Value-based programs
