payment methodologies Flashcards
what are the payment methodologies?
self-pay
fee for service
bundled
Provider reports each service delivered with fee for each…
what is this incentive for?
fee for service
over utilization
One lump sum for each visit regardless of service provided
incentive for what?
per-visit
underutilization
single lump sum per episode of care.
per episode
month/yearly lump-sum for all covered subscribers
who is this high risk for?
capitation
provider
potential to lose money/perform service without payment
who’;s most at risk for:
selfpay
fee for service
bundled
provider risk in payment
patient
payer
provider
options of post-acute care system?
inpatient rehab SNF long-term care hospitals Homehealth OP
how is hospital paid?
fee for service or per diem
how is inpatient rehab paid?
paid per diem by private or managed care payers
Utilize info from IRF patient assessment instrument to classify patients into groups
Prospective payment system
how are SNF paid?
contract/per diem/ medicare part A and b
how are long term care hospitals paid?
PPS prospective payment system
how is home health paid?
medicare
medicaid
fee for service
private pay
Payment rates based of relative weights
Resource based relative value scale
