When responding to your classmates, explain whether you agree or disagree with their conclusions about the best process from a patient’s perspective.
Post #1 :
Hi Everyone. I am working on the Master of Science in Healthcare Administration here at SNHU. I am married with a wonderful adult daughter, a cat, and a dog. We are from Michigan and have been residing in Maine for the last five years. By trade, I am a Radiation Therapist, and a Radiologic Technologist (X-ray tech) and I have worked in healhcare for more then 25 years.
The retrospective reimbursement methodology and the prospective reimbursement methodology are different as to who benefits from them which made me decide to chose one type of reimbursement from each of those methodologies. The global payment reimbursement is a type of the prospective reimbursement methodology which is more advantageous to the third party payer than it is to patients and providers. The global payment reimbursement is where the third party payer makes one combined payment to cover the services of multiple providers and NO higher payments are provided when more complex, more expensive services, or even when a higher volume of services are provided. (Castro, 2018) This type of reimbursement encourages providers to do less on every level- less patients, less complex procedures, less expensive procedures, less expensive diagnostic tests, and less expensive treatments which is terrible for quality patient care and makes providers have to make tough decisions between quality of care and financial stability!!!
The retrospective reimbursement methodology is the fee schedule type of reimbursement and this type is more advantageous to the patients and the providers. Fee schedule reimbursement is where a predetermined set of fees that the third party payer allows which is known as the “allowable charge” represents the average or maximum amount that they will pay. These fees are set in advance. (Castro, 2018) This is better for the patient because this lets providers decide the appropriate services for each patient without considering financial impacts. This is vitally important for quality patient care.