What are the specific reimbursement methods used by each of the major third-party payers?

2. What are the specific incentives and the risks for the providers under the various payment types?

3. What are the differences between insurance-negotiated rates and the private pay fees charged to uninsured patients for health care services? Is there a difference, and if so, how much is it? Provide an example of what is charged for one specific service (appointment, test, etc.).

SLP Assignment Expectations

1. Conduct additional research to gather sufficient information to support your analysis.

2. Provide a response of 4 pages, not including title page and references

3. As we have multiple required items to be addressed herein, please use subheadings to show where you’re responding to each required item and to ensure that none are omitted.

4. Support your paper with peer-reviewed articles, with at least 4 or more references. Use the following link for additional information on how to recognize peer-reviewed journals:

Angelo State University Library. (n.d.).Library Guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www.angelo.edu/services/library/handouts/peerrev.php

5. You may use the following source to assist in formatting your assignment:

Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/

 

 

Module 4 – Background

PAYING FOR HOSPITAL AND PHYSICIAN SERVICES

Required Reading

1. Fact sheet: CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule (CMS 1786-P) (2023). Targeted News Service.

 

2. Fact sheet: FY 2024 Hospital Inpatient Prospective Payment System and Long-term Care Hospital Prospective Payment System proposed rule – CMS-1785-P (2023). Targeted News Service.

 

3. Kaiser Family Foundation. (2019). Paying a visit to the doctor: Current financial protections for Medicare patients when receiving physician services. Available at https://www.kff.org/medicare/issue-brief/paying-a-visit-to-the-doctor-current-financial-protections-for-medicare-patients-when-receiving-physician-services/

 

4. Medicare Payment Advisory Commission. (2023). Physician and other health professionals payment system. https://www.medpac.gov/wp-content/uploads/2022/10/MedPAC_Payment_Basics_23_Physician_FINAL_SEC.pdf

 

5. Oberlander, J., & Laugesen, M. J. (2015). Leap of faith — Medicare’s new physician payment system. The New England Journal of Medicine, 373(13), 1185-1187.

 

6. Chapter 3: Paying for Health Services, pp. 49-81 in:

Reiter, K. L., & Song, P. H. (2018). Gapenski’s fundamentals of healthcare finance (3rd Ed.). Chicago, Illinois: Health Administration Press. Available in the Trident Online Library.

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