Identify the pros and cons of the following reimbursement methods:
Flat-rate reimbursement system
Prospective payment systems:
1. Pros: Rates determined by payers are predetermined and not directly related to historical costs are charges. Under this system, the following units are evaluated to determine the rate: 1.) Per procedure- a payment is made per procedure instead of based on past historical charges/costs of the procedure, 2.) Per diagnosis- the more costly the diagnosis to treat, the higher the reimbursement rate, 3.) Per day- a flat rate is paid to the provider for each day he renders a service to a patient, 4.) Global reimbursement- one payment is paid for an entire procedure in such that the standard components of a service are included to be relevant and necessary and not need to be paid seperately
2. Cons: 1.) Per procedure: this method is associated with high administrative costs and is mainly used in outpatient settings; a past benchmark or measure for a procedure in terms of costs is not used and is instead based on necessity and frequency, 2.) Per diagnosis- diagnoses are ...
Insurance methods within the healthcare system are evolving and offering both a pro and con for the doctor and the patient. This piece identifies the pros and cons of: Prospective-Payment Systems, Cost-Reimbursement Systems, Discounted-Charge Systems and Flat-Rate Reimbursement Systems.
Jones Pediatric: Discusee third party payers, psychologist reimbursement concerns
Jones Pediatric Services offers behavioral health services in outpatient settings. Behavioral health encompasses both psychiatric and psychological services.
Discuss the following:
Whether third party payers reimburse at the same level for services rendered by psychiatrists and psychologists
Psychologists' concerns about reimbursement levels from third party payers
Your feelings on how differences in reimbursement levels affect how healthcare organizations compensate these professionals