11.07.2019 in Medicine

Reimbursement in Healthcare

Reimbursement is a term used in healthcare and it is used to refer to the compensation or the repayment that is made for health care services. In the case of health care, reimbursement is being compensated or repaid for the expenses that have already been already incurred or equally the same repayment for services that have already been provided. Unlike in majority of other dealerships health care service are provided before payments are made thus patients often walk out of the hospital after they have been treated. Considering these circumstances physicians and clinics therefore seeks payments for the services offered as well as the expenses incurred in the treatments and in doing so these physicians, hospitals ,clinics and other health care practitioners and organizations are said to be requesting reimbursement for health care services.

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Reimbursement Methods

Some of the contemporary types of health care reimbursement methodologies include following methods; retrospective fee-for service, managed care, capitation, global payments, episode-of-care, prospective payment systems. The fee-for service reimbursement is a health care method where providers receive payments for each service they render and this method is a common method that is used to calculate health care reimbursement. This method involves setting of a fee meaning that specific payment is made for specific service rendered. Also the health care provider charges a fee for each service provide and the health acre insurance company pays for the covered service. For the self pay method the guarantors of the patient pays specific amount for the service proved by the health care provider. Retrospective payment method involve making of payments after the service has been rendered and this method is historically considered as a traditional method of reimbursement. It’s a fee-for service and a third party reimburse the service providers for costs and charges previously incurred. In addition to that the episode care reimbursement entails making of payments for health care services where providers receives a lump sum for all services provide relating to a disease or a condition.

Based on the successful prospective payment service implemented by Medicare in 1983 numerous future healthcare reimbursements methodologies are a refined and derived from it. Some of the future methodologies include the physician care groups, clinical risk groups and the refinements in the case based payment systems. These classification methods especially the refined case-based payment allows for a accurate comparison of patients in terms of resource consumption, length of stay as well as its outcomes thus enabling hospitals, payers, consumers and regulators to gain an understanding of the treated patients and the costs incurred within reasonable limits and outcomes. This method has been successful in that it helps in enabling clinical precision and meaningfulness when it comes to management of care, reporting and communication. Finally the method enables prediction of payments that are comparable to other risk adjustment systems.



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