Nurse Executive:
Business
Management
with 100%
correct answers
Self-Pay
the individual pays out-of-pocket for care, usually
at non-discounted prices.
Charity Care
Services for which healthcare organizations did not
expect payment because they had previously
determined the patients' or clients' inability to pay.
Health Maintenance Organization (HMO)
provides health care on capitation basis with
members paying set fees to receive all services
Prospective Payment System (PPS)
,Payment according to the specific type of patient
Preferred Provider Organization (PPO)
healthcare services provided to a group of
individuals based on a negotiated fee. Patients
must usually choose physicians within a network to
avoid increased costs
Point-of-service organization (PSO)
Members can receive lower cost coverage if using
in-network providers or may pay more to use out-
of-network providers.
Medicare/Medicaid
includes different options, such as pay-for
performance, prospective payment, PPO, and HMO.
Payment Bundling
a method of reimbursement in which all healthcare
providers engage in an episode of care are
reimbursed through one payment rather than
billing separately for services so that the group is
essentially responsible for the patient rather than
the individual. 4 models being tested.
Payment Bundling: Model 1
Bundling programretrospective acute care hospital
stay only. Payment made for acute hospital care
only
, Payment Bundling: Model 2
Bundling programretrospective acute care hospital
stay plus post acute care: payment for acute care
and related services after DC for 30, 60, 90 days
Payment Bundling: Model 3
Bundling programretrospective post acute care
only: payment for post acute services beginning
within 30 days of hospitalization and ending at 30,
60, 90 days post discharge
Payment Bundling: Model 4
Bundling programAcute care hospital stay only:
payment covers hospitalization, physician care and
other practitioners care. The hospital pays MD and
others out of the bundled payment.
Inpatient Prospective Payment System (IPPS)
Hospitals who receive this type of reimbursement
must complete at least 300 HCAHPS surveys over
four calendar quarters a year.
Pay for Performance (P4P)
performance-oriented incentives for hospitals and
physicians to improve the quality of patient
healthcare
Pay for Performance quality measures
Business
Management
with 100%
correct answers
Self-Pay
the individual pays out-of-pocket for care, usually
at non-discounted prices.
Charity Care
Services for which healthcare organizations did not
expect payment because they had previously
determined the patients' or clients' inability to pay.
Health Maintenance Organization (HMO)
provides health care on capitation basis with
members paying set fees to receive all services
Prospective Payment System (PPS)
,Payment according to the specific type of patient
Preferred Provider Organization (PPO)
healthcare services provided to a group of
individuals based on a negotiated fee. Patients
must usually choose physicians within a network to
avoid increased costs
Point-of-service organization (PSO)
Members can receive lower cost coverage if using
in-network providers or may pay more to use out-
of-network providers.
Medicare/Medicaid
includes different options, such as pay-for
performance, prospective payment, PPO, and HMO.
Payment Bundling
a method of reimbursement in which all healthcare
providers engage in an episode of care are
reimbursed through one payment rather than
billing separately for services so that the group is
essentially responsible for the patient rather than
the individual. 4 models being tested.
Payment Bundling: Model 1
Bundling programretrospective acute care hospital
stay only. Payment made for acute hospital care
only
, Payment Bundling: Model 2
Bundling programretrospective acute care hospital
stay plus post acute care: payment for acute care
and related services after DC for 30, 60, 90 days
Payment Bundling: Model 3
Bundling programretrospective post acute care
only: payment for post acute services beginning
within 30 days of hospitalization and ending at 30,
60, 90 days post discharge
Payment Bundling: Model 4
Bundling programAcute care hospital stay only:
payment covers hospitalization, physician care and
other practitioners care. The hospital pays MD and
others out of the bundled payment.
Inpatient Prospective Payment System (IPPS)
Hospitals who receive this type of reimbursement
must complete at least 300 HCAHPS surveys over
four calendar quarters a year.
Pay for Performance (P4P)
performance-oriented incentives for hospitals and
physicians to improve the quality of patient
healthcare
Pay for Performance quality measures
