Question

During the registration process, a patient financial policy should be given to each patient, the demographics collected, and the insurance verified. At the time of the visit, any amount due, such as the copays or deductibles, should be collected from the patient. Once the patient has seen the provider, the charges are entered, run through an editing system, and claims are submitted to the insurance carrier for payment. Remittance advice comes back from the insurance carrier, the payments are posted. This sounds like a simple process; however, physician payment methodologies are not identical.

For your main Discussion post this week, compare and contrast non-risk-based physician payment and risk-based physician payment. What is the role of a fee schedule with regard to physician payment? How do relative value units (RVUs) affect reimbursement? What are the differences between capitation and Pay for Performance (P4P)?

Answer 1

A patient went to the hospital for getting treatment means he has to pay the amount fully if he doesn't have any health insurance plans.

If he has any health insurance plans he can get treatment for free as with out paying amount to hospital or after paying reimbursement from the insurance company by providing bills as services taken from hospital. If the patient didn't paid any amount and get the treatment from the hospital then the service provider means hospital department will submit the claim for getting paid the amount from the Insurance company for given service to their insurers .

One more method is third parties if the patient get the treatment without paying and the third party will pay for that treatment and get reimbursement from the insurance company as they made contract with them to provide the amount on getting treatment and reimbursement from client of insurance company  

The contract non risk based physician is nothing but third parties which they won't provide treatment to patients just they give money for giving treatment to patients and they reimbursement from insurance company.

The contract risk based physician is direct provider who provide treatment to patients by contract between the insurance company .

Relative Value Units are very helpful in analyzing reimbursement performance. You can certainly analyze your Medicare reimbursement using RVUs . You can also use RVUs to evaluate reimbursement for all of your other payers like providers, third parties.

The Most capitation models are also include value-based incentive payments and penalties based on quality and cost performance.Global capitation arrangements reimburse providers with a single, fixed payment for all the healthcare services given to a patient, including primary care, hospitalizations, and specialist care. And the financial reward system for employees where some of all their monetary compensation is related to how their performance is assessed relative to stated the criteria. Performance related pay can be used in a business context for how an individual, a team or the entire company performs during a given time frame.