Question

Q 2.7 Describe the provider incentives under each of the following reimbursement methods: a. Cost based b. Charge based (including discounted charges) c. Per procedure d. Per diagnosis e. Per diem f. Bundled payment g. Capitation

Answer 1

Cost based reimbursement: This is a kind of payment that is based upon the cost of the resources that is consumed by the patient.here the service is first render by the provider before payment is made. The payer makes periodic interium payment (PIP) to the provider 2) Charge based reimbursement: This occur when the payer pay charges according to the rate schedule by the provider, also in discounted charge the provider provides service based on fee-for -service basis but with the fee deduce.3)Per procedure reimbursement: The provider is paid a rate based on procedure performed on a patient. This is commonly used in outpatient than in in patient settings. 4)Per diagnosis reimbursement: A patient pay the provider based on the rate of diagnosis the patient receives .5) Per diem reimbursement: here a service provider is paid by day based on the service provided.The provider get different daily cost to a rate that is supplied by service provider. 6) Bundle reimbursement: Here, payment is done to cover all service delivered in a single episode,it may either be render by a single provider or multiple provider.7) Capitation reimbursement: This is treated as a separate method because in this ,the provider are reimburse base on the amount of service provided.capitation payment is used purposely by manage care plan. also in capitation payment, provider is paid fixed amount per covered life usually per period which is usually monthly.