Hospitals, physicians and other care providers require being paid in a more systematic manner to help enhance quality of healthcare that too at a low cost. The current fee-for-service system in the US through which physicians are paid has been considered a major reason for escalating costs in the healthcare system.

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Understanding the Various Components Encompassing New
Payment Models!
Hospitals, physicians and other care providers require being paid in a more systematic manner
to help enhance quality of healthcare that too at a low cost. The current fee-for-service system
in the US through which physicians are paid has been considered a major reason for escalating
costs in the healthcare system.
Under this system, physicians are rewarded financially for more services, especially expensive
services. When it comes to efficiency, healthy patient outcome or care co-ordination, there are
no financial rewards provided under fee-for-service payment system. As a result for decades,
the US government has been trying to reduce healthcare costs.
However with the Patient Protection and Affordable Care Act passed in 2010, a renewed effort
has been made by the government and commercial health insurers to control costs with
multiple payment models for hospitals and physicians. Diverse payment-models are evolving
that physicians may opt for; they include Pay-for-Performance
As per the P4P model, financial incentive is paid to physicians by health insurers based on their
achievement of certain defined goals related to patient experience, resource usage and care
processes. P4P model offers rewards only for improving chronic conditions of patients. However
under this payment model, physicians may end up offering additional services and spending a
lot of time only on chronically ill patients.
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Bundled Payment
In a bundled payment model, a single sum covers healthcare services that are delivered by two
or more providers over a specific time span or during a single episode of care. This payment
model rewards physicians for curing patients with only a certain chronic illness like asthma,
cardiovascular disease or diabetes. If cost of services is less than the bundled payment, the
difference will be retained by the participating physicians and other healthcare providers. But if
the cost exceeds the bundled payment, physicians and providers will not be compensated for
the difference.
Shared Savings
Through this payment model, a physician group or an association of physicians is provided a
percentage of any realized net savings for reducing health care expenditure for a certain
population of patients. Shared savings is applied to some or all services expected to be used by
that patient population.
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2. Call now
888-357-3226 (Toll Free)
http://www.medicalbillersandcoders.com
End to End Medical Billing Solutions
Global Payment
Under this payment model, a budget is set for the care of a population of patients and the group
of physicians or association of physicians is paid from it. In case the spending comes below the
budget, all savings can be retained by the physicians; however, they will have to bear financial
risks if expenditure goes beyond the budget.
Above are few value based models which physicians may opt for to increase quality of patient
care, and numbers of patients. While physicians are busy migrating from fee-for-service
payment model and focusing on value-based clinical activities, they may face various billing
challenges and an efficient billing partner may be an optimal solution to help handle the rising
tasks of billing, coding, claim filing and documentation.
Medicalbillersandcoders.com has a team of experienced medical billers that can help and guide
physicians to handle the operational side of a practice’s value-based payment model. This will
give ample time to physicians to focus on patient care. MBC for over a decade now has been
successfully dealing with medical claim filing for physicians across 50 US states, relieving them
from the headache of managing their monthly funds and revenue cycle.
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Copyright ©-2013 MBC. All Rights Reserved.
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