7-2

Payment Methodologies

Resources

• Discussion and Participation Scoring Guide.
• Overhauling the U.S. health care payment system.
• Association of managed care market share and health expenditures for fee-for-service Medicare patients.
• Center for Medicare & Medicaid Services.

At this point you have been introduced to prospective payment and reimbursement systems for hospitals. In this discussion, select two systems and explain what each is and how they work.

Use Web sites that pertain to managed care, government funded health plans, and preferred provider organizations to help in your research.

Once you are done, refer to the Discussion Participation Scoring Guide to make sure you have met the requirements of this discussion.

Response Guidelines

Read the posts of your peers and respond to two posts. Try to select a peer that chose a different system than you and try to select a peer that chose the same system as you.

• For the peer who chose a different system:
  • If given just the information provided by your peer, are you clear on how the system works?
  • What questions do you have for your peer in relation to the systems selected?
• For the peer who chose the same system as you:
  • Compare your description with your peer's. Are there inconsistencies in your description and theirs? Explain.