HFM_Unit_2_Discussion(1) HFM_UNIT_2 Discussion 1.Review managed care contracts for dif

HFM_Unit_2_Discussion(1)    HFM_UNIT_2 Discussion  1.Review managed care contracts for different payment plans (PPO, HMO, Fee for services, etc.) and describe provider incentives and risks under each of the following reimbursement methods:  a.Cost-based (fee-for-service)  i.   Insurance companies make payments to providers based on the allowable cost of services provided to patients, as outlined in the patients policy.  ii.  Provider Incentive: order/provide more services to increase revenue  iii. Provider Risk: over-provision of services can easily become a national problem by making healthcare costs rise.  b.   Charge-base (including discounted charges) (fee-for-service)  i.   Insurance companies make payments to providers based on the charges associated with the care provided to the patients.  ii.  Provider Incentive: Can set higher charge rates to bring in more revenue. iii. Provider Risk: discounted “negotiated payments” may dissuade providers  from providing care in the form of certain types of tests or procedures that do not bring in enough revenue and therefore put the patient at risk of 1) not having necessary tests run or 2) having unnecessary tests run just to bring in more revenue for the provider.  c.   Per procedure (fee-for-service: prospective payment)  i.   A reimbursement methodology that pays a set amount for each procedure. ii.  Provider Incentive: provide more procedure services (primarily used in  outpatient services)  iii. Provider Risk: high administrative costs  d.   Per d