Physician Reimbursement Directions With the increasing cost of health care, MCOs
ID: 335109 • Letter: P
Question
Physician Reimbursement Directions With the increasing cost of health care, MCOs have been under tremendous pressure to control health care costs, including physician reimbursement. In this assignment, you are to look at some of the issues that are involved in physician reimbursement. Your assignment is to write a 2 to 3 page paper that addresses the following: • What are the different methods that MCOs reimburse providers for health care services? • How does reimbursement for these services vary based on the type of MCO models (Group, Staff, IPA, PPO…) • In which situations would member/patients pay the MCO directly? • How do you think reimbursement impacts how care is delivered to the patient? • Is this good or bad? Provide examples, • Cite your resources. Physician Reimbursement Directions With the increasing cost of health care, MCOs have been under tremendous pressure to control health care costs, including physician reimbursement. In this assignment, you are to look at some of the issues that are involved in physician reimbursement. Your assignment is to write a 2 to 3 page paper that addresses the following: • What are the different methods that MCOs reimburse providers for health care services? • How does reimbursement for these services vary based on the type of MCO models (Group, Staff, IPA, PPO…) • In which situations would member/patients pay the MCO directly? • How do you think reimbursement impacts how care is delivered to the patient? • Is this good or bad? Provide examples, • Cite your resources. Physician Reimbursement Directions With the increasing cost of health care, MCOs have been under tremendous pressure to control health care costs, including physician reimbursement. In this assignment, you are to look at some of the issues that are involved in physician reimbursement. Your assignment is to write a 2 to 3 page paper that addresses the following: • What are the different methods that MCOs reimburse providers for health care services? • How does reimbursement for these services vary based on the type of MCO models (Group, Staff, IPA, PPO…) • In which situations would member/patients pay the MCO directly? • How do you think reimbursement impacts how care is delivered to the patient? • Is this good or bad? Provide examples, • Cite your resources.Explanation / Answer
Introduction:
Tremendous increase in health care services have been observed in recent times. Heath care has become so costly that it has gone out of capacity of a common man. This is one of the biggest concern for service providers.
Managed Care Organizations (MCOs) are under tremendous pressure to control health care costs.
Physician Reimbursement:
It has been identified by many scholars and researchers that physician reimbursement absorbs a big portion of heath care cost in the U.S. Managed care has their own rules and regulations for reimbursement.
Different methods that MCOs uses to reimburse providers for health care services:
Health plans have four plans for paying physicians these include:
Apart from above three payment adjustments are also concerned with physicians reimbursement, these are as follows:
Reimbursement for services vary based on the type of MCO models:
There are several models of health maintenance organizations, some of the common models are as follows:
The situations in which member/patients pay directly to MCO:
In my opinion the reimbursement impacts the way care is delivered to the patient in following manner:
I believe that such a influence of reimbursement an heath care is not a good. Although it is helpful for one who can afford it to gain advantage from this pattern. But for those who cannot afford managed care organizations, it becomes tough.
References: