The Medicare Prospective Payment System And Financial Risk
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The Medicare Prospective Payment System And Financial Risk
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Author : Maqbool Dada
language : en
Publisher:
Release Date : 1990
The Medicare Prospective Payment System And Financial Risk written by Maqbool Dada and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1990 with Hospitals categories.
An Examination Of Winners And Losers Under Medicare S Prospective Payment System
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Author :
language : en
Publisher:
Release Date : 1991
An Examination Of Winners And Losers Under Medicare S Prospective Payment System written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1991 with Hospitals categories.
The Interaction Between Payment Adjustors And The Size Of The Outlier Pool Under Medicare S Prospective Payment System
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Author : Grace M. Carter
language : en
Publisher: Rand Corporation
Release Date : 1993
The Interaction Between Payment Adjustors And The Size Of The Outlier Pool Under Medicare S Prospective Payment System written by Grace M. Carter and has been published by Rand Corporation this book supported file pdf, txt, epub, kindle and other format this book has been release on 1993 with Hospitals categories.
The authors have explored the implications of a simultaneous increase in outlier payments and decrease in the extra payments to teaching and disproportionate share hospitals. The authors simulated payments to a random sample of FY 1990 Medicare discharges under a set of six alternative payment policies which are combinations of two levels of outlier payments and three payment adjustment policies. A simultaneous increase in outlier payments and a decrease in the payment rates for teaching and disproportionate share hospitals could provide modest improvements in the correspondence between costs and reimbursement at the hospital level and at the case level. In the authors' simulations of an outlier pool equal to 10 percent of federal payments and a reduction of the operating payment factors to the level of the capital adjustment, they found that reimbursement to the quartile of hospitals that earn the smallest amount from their Medicare cases would increase by 2.12 percent and that to the highest earning quartile would decrease by 4.00 percent. The same policy would also reduce hospitals' financial risk. Reducing the size of the payment factors would, of course, reduce payments to teaching and disproportionate share hospitals. On average these hospitals earn substantially more than other hospitals on their Medicare cases, but within the group of teaching and disproportionate share hospitals there is a wide range in Medicare profit and in total margin. Increasing the outlier pool and removing the standardization in the cost outlier formula effectively ameliorates the effect of the reduced IME and DSH payments on the subset of IME and DSH hospitals that receive very low earnings from Medicare patients. The simulated policies would have little effect on the distribution of total margins. The variations in Medicare profit and in total margin limit the extent to which the PPS can be improved based on changes in the payment adjustments for the existing categories of hospitals.
Why Don T Commercial Health Plans Use Prospective Payment
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Author : Laurence Claude Baker
language : en
Publisher:
Release Date : 2016
Why Don T Commercial Health Plans Use Prospective Payment written by Laurence Claude Baker and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016 with Health insurance categories.
One of the key terms in contracts between hospitals and insurers is how the parties apportion the financial risk of treating unexpectedly costly patients. “Prospective” payment contracts give hospitals a lump-sum amount, depending on the medical condition of the patient, with limited adjustment for the level of services provided. We use data from the Medicare Prospective Payment System and commercial insurance plans covering the nonelderly through the Health Care Cost Institute to measure the extent of prospective payment in 303 metropolitan statistical areas during 2008-12. We report three key findings. First, commercial insurance payments are less prospective than Medicare payments. Second, the extent of prospective payment in commercial insurance varies more than in Medicare, both across hospitals and geographic areas. Third, differences in prospective payment across hospitals are positively associated with the extent of hospital competition, the share of the hospital’s commercially insured patients covered by managed-care insurance, and the share of the hospital’s patients covered by Medicare’s Prospective Payment System.
An Evaluation Of Medicare Payments For Transfer Cases
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Author : Grace M. Carter
language : en
Publisher:
Release Date : 1993
An Evaluation Of Medicare Payments For Transfer Cases written by Grace M. Carter and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1993 with Diagnosis related groups categories.
The authors investigated how the costs of transfer cases are related to length of stay (LOS) and to the resource intensity of the DRG. The authors use this relationship to develop alternative payment formulas for transfer cases and evaluate the effect of these alternatives on the adequacy of payment for transfer cases, on hospitals that transfer a high proportion of their cases, and on the distribution of reimbursement and risk among groups of hospitals. The average daily cost of transfer cases declines with LOS, but at a decreasing rate. After controlling for LOS, the standardized cost of a case is approximately proportional to daily DRG weight and to the payment for a typical day in the DRG. These facts led the authors to develop a payment formula that results in a 30 percent improvement in the match of payment amounts to transfer care costs. The policy is similar to adding payment for one extra day to the current payment amount. It increases reimbursement to the ten percent of hospitals with the highest fraction of transfer cases by 1.5% and reduces their financial risk by 2%. The policy has very little effect on other hospitals. The authors also simulated a policy which increased outlier payments for transferring hospitalizations. This policy appears to have only a modest effect. A future report will examine the cost of care at the recipient hospital, total cost for the entire episode, and the care delivered during the episode.
Health Care Finance And The Mechanics Of Insurance And Reimbursement
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Author : Michael K. Harrington
language : en
Publisher: Jones & Bartlett Learning
Release Date : 2023-10-27
Health Care Finance And The Mechanics Of Insurance And Reimbursement written by Michael K. Harrington and has been published by Jones & Bartlett Learning this book supported file pdf, txt, epub, kindle and other format this book has been release on 2023-10-27 with Medical categories.
Health Care Finance and the Mechanics of Insurance and Reimbursement combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Updated throughout the Third Edition offers expanded material on financial statements; new and expanded Skilled Nursing Facility examples; and enhanced sections on PDPM, Practice Management for Primary Care and other Specialties, Clearinghouse Processes, Predictive Modeling (data mining), and more.
Medicare S Prospective Payment System
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Author : United States. Congress. Office of Technology Assessment
language : en
Publisher:
Release Date : 1985
Medicare S Prospective Payment System written by United States. Congress. Office of Technology Assessment and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1985 with Government publications categories.
Accounting For Social Risk Factors In Medicare Payment
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Author : National Academies of Sciences, Engineering, and Medicine
language : en
Publisher: National Academies Press
Release Date : 2016-10-14
Accounting For Social Risk Factors In Medicare Payment written by National Academies of Sciences, Engineering, and Medicine and has been published by National Academies Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016-10-14 with Medical categories.
Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver. Accounting For Social Risk Factors in Medicare Payment: Data is the fourth in a series of five brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report provides guidance on data sources for and strategies to collect data on indicators of social risk factors that could be accounted for Medicare quality measurement and payment programs.
Medicare Prospective Payment And The Shaping Of U S Health Care
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Author : Rick Mayes
language : en
Publisher: JHU Press
Release Date : 2006-12-20
Medicare Prospective Payment And The Shaping Of U S Health Care written by Rick Mayes and has been published by JHU Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2006-12-20 with Law categories.
health care system.--Andrew B. Whitford "International Public Management Journal"
Prospective Payment To Medical Staffs
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Author : W. Pete Welch
language : en
Publisher:
Release Date : 1988
Prospective Payment To Medical Staffs written by W. Pete Welch and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1988 with Diagnosis related groups categories.
