I would like to welcome you to my presentation of the Payment methods there are as in the Capitation Cycles and the fee-for-service .There will be a part on the relationship among provider, patient, and their roles in each of the processes. I hope to be able to show how in the aspect of the relationship among the Providers, the patient, and the most important one of the entire payer due to if there was no payer then there would be no need for a physician medical billing department to do their billing. The involving of merging would not take place if we didn’t have the patients or even the provider.
Is if the Doctor has 500 patients and sees only 400 0f those patients with a period of a time he still gets paid for the 500 patients. In the aspect of the patient it could be looked at as a way of even if he doesn’t make the appointment the provider still gets paid by the insurance plan. When the capitation payment is used the financial risk for care of the patient is transferred to the medical system, this payment method only works if the physician and the hospital are integrated either by a contract or an organization with a population that is sufficient for medical serves that are utilized. The population has to have a reasonable degree of certainty that must be met for this type of health care to work. With thios one the quality of care does not provide the patients with much quality of care There are 6 steps to a methodology for putting together and establishing the rate of the capitation payments are; Determine the delivery system cost base,
Develop use rates,
Calculate capitation rates,
Adjust the rates, for when the impact of the incremental volume,
Talking about the upcoming contract to avoid any mistaken part of the contract that could happen,
Keep watch on how the performance of the cycle goes.
Fee-for-service is where the patient or the insurance that they have pays for all services separately as in the appointments, tests, or another type of medical that is needed. Most of the patients that have this type submit a claim to their insurance so they can be reimbursed for what they paid for the services. This has a higher payment for the patient as in a higher copayment or higher deductibles.