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QUESTION

(200 Words)Review managed care contracts for different payment plans (PPO, HMO, Fee for services, etc.) and describe provider incentives and risks under each of the following reimbursement methods:Cos

(200 Words)

  1. Review managed care contracts for different payment plans (PPO, HMO, Fee for services, etc.) and describe provider incentives and risks under each of the following reimbursement methods:
    1. Cost-based
    2. Charge-base (including discounted charges)
    3. Per procedure
    4. Per diagnoses
    5. Per diem
    6. Global pricing
    7. Capitation
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******* **** ******** *** ServiceFee *** ******* plans ******** *********** ***** ** *** ******** ********* *********** cost-based ************* ******** ******* *** ******** ** profitability The ******** **** **** ******* lower ******* **** ***** ****** ************ (including ********** charges)The ******** *** *** ******* ** determine ***** ******* A ********* **** ******** finding payer unwilling ** ****** to *** ************ **** schedule3 *** ************ ******** ** **** to *** ************ *** all procedure ********* *** ******** ***** **** ** ** compensated for the ********** procedure **** **** *** **** *** been ********* *** ************ ******** ***** **** diagnosis The ******** might be *********** ** *** ****** ********* ****** *** ************* **** if *** ********** *** simple *** ********* risk ****** ** *** services provided *** *** many to get ******** ****** ********** ******** ***** if *** prices *** ********* The provider ***** ** ***** ***** *** higher **** **** ** their ************ ****** the ****** ******************* **** ** *** patients make ****** ***** their capitation ********* **** ** *** patients make visits ****** ***** *************** ** ******* PlansThe point of ******* plan ****** clients ** *** ******** **** providers outside *** ******* ** *** physician makes the ******** *** whole **** is ******* ** the **** ******* ** the ******* ******* *** *** referral **** will *** coinsurance ********** ** other additional ****** ************ *** POS ** ********** *** ******** risks failing ** get * ************* if **** ** the **** ******** ****** the ******** ** not allowable They *** however ********** ** *** ********* **** ****** ***** they *** ******* of ************* ************ ********** ********** **************** in *** *** plan ** ********* ***** **** *** charge *** ***** **** ***** ****** ********* A ******** risk occurs ** *** **** ** the bulk ** the **** ** ********* *** ************ ******** provider will ** compensated *** those ********** ****** making * referral The ******** ***** losing ** **** ******* * ********* that is ********* ***** *** referral4 Per ************ ******** ** motivated ** the ******** ** ** * lower ************* The ******** ***** ** the ********* ******** ** ** * ****** reimbursement5 *** ******* ******** ***** if the referral involves * ******* **** *** ******* been ******** *** provider ***** ** *** ******** ******** * ******* **** they *** *** to provide *** *** ********* ******* Global ********** provider ***** ** the ******** gives ***** ******* *** provider risks losing ********** ******* ** ********** ************* ******** ***** **** ********* to patients **** **** exhausted ***** ******* ********** *** ******** ***** ** *** patient referred *** *** activated ***** capitation ************* ******** ************* *** is * ****** **** **** **** ** ******* providers on *********** ***** ******* the ******* providers may ** ********* *** ******* *** ****** * ******* ** ******** ******** providers **** * patient *** his ** her *** preference *** *** medical organization1 Cost basedIt ** ******* **** *** fall **** of *** ******** ******* ******** ** ********** costs can be **** out ** *** ******** Charge ******** ******* **** ****** *** network *** agreed upon ** *** ******* providers **** ** ** ********* based3 *** ****************** *** ********* within **** ******* plan ** cheap ***** ** *** ************ by the ******* ******* ***** ***** and treatment can ** done ******* of *** ******* ** ** ********** ***** Per ************** ** *** ******** ***** * ********* can be ********* ***** ** * ******* **** ** the ******* **** ***** ***** *** incurred ** *** subscriber5 *** ******* ******* ** ***** ***** *** ****** the network **** ******* ********* may ****** ** different terms than **** ** *** **** ****** ********* ** cheap to *** ****** providers as **** ****** ***** at ********** *** ************* **** ***** *** *** *** within the ******* **** *** ******* **** ****** ******* *** ****** on a ******** plan *** that *** ** *** * *********** ************* *** ******** ***** ** the ******** *** below *** capitation *** provider ***** if the ******* is above *** ************

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