In distinction with a DFS, capitation reimbursement gives a chance to the Managed Care Organization (MCO) to shift almost all the risks and cost of health care to the provider. In most cases, the provider is not allowed to request the MCO or any individual for extra reimbursement even if the amount used is far beyond the projected amount (Niles, 2010). Diagnosis Related Groups (DRGs) In the Diagnosis Related Groups health care program, DRGs pays health care providers are paid on prospective terms while factoring in diagnoses and procedures. These are determined and classified to give them codes referred to as diagnosis related groups (DRGs). The allocated codes show a monetary value to show what the services rendered to the patient should cost. The government pays health care providers a flat charge for each DRG. This charge doe not depend on the number of days an individual spend in the health care facility or the actual cost of care. The health care provider is obliged to administer its costs within the DRG charge (Niles, 2010). Future of Health Care Reimbursement One area where changes are taking place is in the business of health insurance and health care delivery. Increasing health care costs have become a major national issue. In the early 1990s, it seemed likely that there would be significant changes in the health care delivery based on federal health care reform. It now appears that legislative reform will occur primarily at the state level if at all. But regardless of what happens in the state and national legislatures, market forces almost certainly will continue to produce sweeping changes in American health care reimbursement system. The driving force behind market place reform is in the need for employers to decrease, or at least stop, the cost of providing employee health care (Niles, 2010). Many health care practitioners suppose that more than half of all health care costs-- the costs of overstuffed transactional procedures as well as unsuitable measures, service sites and prescription drug levels offer no worth (Health care policy, 2012). “For perspective, this year we'll unnecessarily spend nearly $1.5 trillion on health care, an amount equivalent to the budget deficit. Though we continually have given physicians and the health care industry a pass on this issue, its impact can be understood as the difference between our national prosperity and decline. (Health Care Policy, par 3) The present reimbursement undervaluing of health care is one of the challenges distressing the health care reimbursement. The other challenges affecting the service include fee for service reimbursement and the absence of cost, quality and safety intelligibility. These challenges lead to extra spending and prohibit hospitals from operating in a true market (Health care policy, 2012). Health Care Reimbursement and Student Organizations Changes in Medicare policies governing payment to physicians providing care services in teaching hospitals also have the potential to affect adversely the Graduate Medical Education institutions (GME) activities. Recent changes in the regulations governing payment to teaching physicians place new requirements on the role of teaching physician in the patient care activities of resident physicians as their documentation of that role in the medical record. Because approximately two thirds of the costs for the GME program activities at
Capitation Capitation can be defined as monthly repayments of a permanent value of health cover evidently stated services for a given populace on a per-member per-month basis. The health care provider who accepts the use of capitation takes the financial risk of ensuring that individuals are provided with efficient and defined services…
Segmentation involves dividing the market into clear groups of consumers called a segment, where each group has definite similarities within the group, but is distinct from the other groups, so that the marketing mix of the company can be made suitable for the market segments chosen as the target market
PPOs can be either risk bearing or non-risk bearing in which a risk-bearing PPO combines the insurance, or payment, function with the management of the network of providers (North Carolina Institute of Medicine, n.d.). On the other hand, a non- risk-bearing PPO focuses solely on network management, not on the insurance function.
ost airlines and the general consciousness to conserve and explore the natural wonders have resulted in the surge in demand for travel packages that caters to both. The journey has not been easy. After the deleterious effects of the ongoing global warming and climate change
These inks are environmental friendly. The best aspect of this product are the four unique parts of Ecoboard which are flat packed to provide easy transport.
The business plan aspires to cash in on environmental friendly products and using them to offer utility
The product concept involved the use of recyclable and environmentally materials such as vegetable glue to make joints and soya inks for decoration. This product development puts the concept of environmental sustainable in mind and
A. the market supply is the total amount supplied by all the suppliers at the existing price. For example at price 35, the 1st supplier is willing to supply 60 units, the 2nd supplier 55 units and 3rd supplier 40 units. Therefore the market supply at that price is
Molecules at S0, S1, and S2 have distinguishing characteristics. It can also be studied in an ESP spectroscopy. It involves electronically exciting and quenching a molecule.
Polarization helps in identification of