Discussion Topic- Concepts of Managed Care
During the registration process at a provider’s office, a financial/payment policy should be given to each patient, the demographics collected, and the insurance verified. At the time of the visit, any amount due, such as the copays or deductibles, should be collected from the patient. Once the patient has seen the provider, the charges are entered, run through an editing system, and claims are submitted to the insurance carrier for payment. Remittance advice (aka: checks) comes back from the insurance carrier and the payments are posted. This sounds like a simple process; however, provider payment methodologies are not identical.
For your main Discussion posts this week, compare and contrast non-risk-based and risk-based physician payments.
What is the role of a fee schedule with regard to physician payments? What are the differences between capitation and Pay for Performance (P4P)?
At Least 250 words.
This assignment aligns with the following Learning Objective : LO2
Chapter 4
Course Materials: Required Textbooks:Kongstvedt, P., Health Insurance and Managed Care: What They Are and How TheyWork, 5th. Edition. Sudbury, MA: Jones and Bartlett.ISBN- 978-1-284-15209-8 or EBook-ISBN-978-1-284-09487-9
