BACKGROUND The Balanced Budget Act of 1997 introduced 2 new reimbursement structures, the Interim Payment System (IPS, 1997-2000) and the Prospective Payment System (PPS, begun October 2000) for Medicare home health agencies (HHAs) under the fee-for-service program. OBJECTIVE This article describes and compares the impact of these changes on the Medicare home health market from a period befor...

Preface The Payment Reform: Current and Emerging Reimbursement Models white paper is an American College of Cardiology (ACC) member content-driven educational resource meant to provide baseline knowledge of the payment models proposed in the Patient Protection and Affordable Care Act (PPACA) and the innovative payment pilots already being implemented in the private sector. Recognizing that chal...

conclusions with regard to the current challenges in iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. however, future research should focus on the development of the risk-adjusted capitation model. background when a country’s health system is faced with fundamental flaws that require the redes...

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that details a consolidated pay-for-performance provider payment system within the Medicare Access and CHIP Reauthorization Act. This proposed rule establishes policy for the new provider Merit-Based Incentive System and Alternative Payment Models. While the rule is extremely complex, and not yet finalized, there ar...

Background: Unnecessary patient admission to a hospital refers to the hospitalization of a patient without clinical indications and criteria. Various factors related to the patient (e.g., age, disease severity, payment method, and admission route and time), the physician and the hospital and its facilities and diagnostic technologies affect a patient unnecessary admission in a hospital. Unneces...

The Employee Retirement Income Security Act of 19741 ("ERISA" or "the Act") is a comprehensive federal statute which imposes minimum standards on employee benefit plans. To prevent conflicting state regulation, ERISA preempts state laws which "relate to" these plans. 2 ERISA's preemption, however, is not complete. Consistent with the federal policy embodied in the McCarran-Ferguson Act 3 of lea...

Fee-for-service, the predominant method of paying for health care in the United States, is an unsustainable payment approach that rewards volume, resulting in an increase in the number of health care services that are provided, regardless of the outcome of the service. Many believe this form of payment has contributed greatly to the ever-increasing costs of health care. Payment reform, which en...

The purpose of this study is to examine the use of statistical and data mining tools to investigate the funding mechanism for healthcare providers. The specific objective is to examine the relationship between the total charges billed by a hospital compared to the payments received for patient care. Currently, hospitals receive a negotiated payment for a particular diagnosis. The payment is bas...