From a long period of time, the healthcare industry has followed the traditional model of payment for claims settlement – fee-for-service model – where specified amount has to be paid for the healthcare service. Recently, the health insurance companies are adopting to new payment models, and they have actively begun considering and testing the new payment options.

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New Payment Models Transform the Role of Medical
Billing
From a long period of time, the healthcare industry has followed the traditional
model of payment for claims settlement – fee-for-service model – where specified
amount has to be paid for the healthcare service. Recently, the health insurance
companies are adopting to new payment models, and they have actively begun
considering and testing the new payment options.
The main objective of this is to change the way medical practitioners, hospitals, and
other healthcare providers are paid. In other words, the reform in the payment
model is made to improve the quality and reduce the use of unnecessary and costly
services.
As per the traditional payment system, physicians and health care providers gets
their payment based on the tests and procedures used for the treatment. The time
doctors spend with their patients is not considered during reimbursement. This
causes displeasure amongst both physicians and the patients. Hence more and more
physician is opting for alternate models of payment, where they can provide best
healthcare to their patients.
The shift from traditional fee-for-service model will make it more difficult for
physicians, health care providers, insurance companies, and payers to get adjusted
to the new payment reforms. Without proper guidance about the working of new
payment reforms, this will be a challenge for the physicians and the healthcare
providers to get generous reimbursement for their services. The main challenge will
be choosing the most appropriate model of payment, viz. pay for coordination, pay
for performance, episode/bundled payment, and comprehensive care/total cost of
care payment. Reformation in the federal health policy have opened the gates for
Accountable care organizations, medical homes, and bundled payments. Due to
these changes, many physicians are inclined to change the traditional payment
option.
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Few of the more popular modes of payment amongst the masses are:
Episode/Bundled Payment, where the physicians get single payment for
“bundles” of related services rather than separate payments for each service during
an episode of care. This ensures better-coordinated and more efficient care and
reduces the need of providing unnecessary treatment.
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2. Call now
888-357-3226 (Toll Free)
http://www.medicalbillersandcoders.com
End to End Medical Billing Solutions
Pay for Performance, where the physicians receive payment for achieving
defined and measurable results related to patient experience, resource use, and
other factors.
Pay for Coordination, where the health care providers get periodic
reimbursement for specified care coordination services. This model is
applicable only for certain types of healthcare providers.
Comprehensive Care, where the physicians receive a single risk-adjusted
payment for complete health care services needed by a patient/specific
group of people for a certain fixed period of time.
The risk associated with adopting the new model is not just limited to selecting the
most appropriate model of payment. Practical feasibility of these models in terms of
financial and operational setup should also be considered. Moreover with each model
the need for accuracy in documentation and coding becomes even greater, hence
necessitating a well organized billing process. Further demonstrations of these
models in the functional environment are required to fully understand advantages,
disadvantages, and operational feasibility of these models.
Medicalbillersandcoders.com is the ultimate medical billing organization with
incomparable expertise in all the aspects of models of payment. Our experts have
studied each of these models extensively, and we have immense knowledge on pros
and cons about each of the model. Moreover, our billing specialists provide support
to practitioners based in all US states and our experts handle billing for over 40
specialties.
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