Reimbursement Options

Assume you are a reimbursement specialist for a large primary care office. While you are aware that your providers are reimbursed in several different ways, the providers are uncertain as to what each reimbursement type means for the practice in terms of collections. For this assignment, you will prepare a 3–5 page document outlining the different reimbursement options to which the practice is subject for the providers in the group.

Patient scenario: For the purposes of this assignment, base your write-up on a patient coming to the office and being seen for the first time (new patient consult). Charges for the consult are 500 dollars.

Identify the various reimbursement options for the provider:

Fee-for-service.
What is it?
Consider health care spending and cost control; what are the drawbacks of this model?
Capitation.
What is it?
What are the potential drawbacks of this model for the physicians who are driven to provide comprehensive services to their patients?
Pay for performance.
What is it?
How does this model impact reimbursement rates?
Resource-based relative value scale or case-based payment.
What is it?
How can this model potentially encourage an overuse of services?
Explain what payment options would be available if the patient in question was uninsured.

Medicaid.
How does the patient qualify?
Financing options.
What is this method?
Self-pay.
How would the patient be charged? A percentage of commercial contracts or a percentage of Medicare?
Charity care.
How would you screen a patient for charity care?
What process would you implement to qualify a patient for charity care?
Support your findings with at least two peer-reviewed sources.

Resources

Reimbursement Options Scoring Guide.
APA Style and Format
Capella Writing Center.
Find Scholarly and Peer Reviewed Sources.
Health Care Administration Undergraduate Library Guide.
APA Paper Template.
APA Paper Tutorial.

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