A health plan's approach to provider reimbursement is rooted in the need to move from traditional fee-for-service models to a payment model that accounts for providers adhering to best practices.
Proactive fraud detection programs should identify bogus claims before the money is paid out
Coordination of care helps decrease costs and ensures effect use of resources
If more patients are covered by Medicaid, hospitals stand to become unstable under reimbursement of 88 cents on the dollar
State of the Industry survey results
The shortage of oncologists and the increasing numbers of cancer survivors combine to produce a classic case of demand exceeding supply
MedPAC reports 2009 MA payments will be 14% above fee-for-service rates.
Payment structure among stakeholders must be equitable in order to avoid contract disputes and provide the highest quality of care to consumers.
Payer initiatives will encourage consumers to make educated choices, especially since prices can vary so dramatically.
CMS will begin demonstration projects to further test the promise of P4P by bundling payments for certain services as single case-rates