The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

MODERN CONSIDERATIONS

***

By Dr. David E. Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

EMERGING HYBRID PAYMENT MODELS

Current reimbursement structures involve the submission and payment of medical CPT® coded claims. But, some doctors feel they need to “up-code” to maximize revenue or “down-code” for fear of having a claim denied. Contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.

CITE: https://www.r2library.com/Resource/Title/0826102549

This hybrid reimbursement system might use a two-payment structure.

For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.

The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.

Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar.

YOUR COMMENTS ARE APPRECIATED.

Thank You

INVITATIONS: https://wordpress.com/post/medicalexecutivepost.com/246863

***

Filed under: "Doctors Only", Accounting, Career Development, CMP Program, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Research & Development, Touring with Marcinko | Tagged: capitation, CPT codes, physician payment, Physician Reimbursement |