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Building global billing and payment systems.

R B Schmitz1

  • 1ORION Consulting, Cleveland, OH, USA.

Managed Care Quarterly
|June 3, 1999
PubMed
Summary
This summary is machine-generated.

Global fees for episodes of care offer a progressive approach to managed care contracting. However, outdated billing systems hinder their widespread adoption, despite theoretical advantages over fee-for-service and capitation models.

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Area of Science:

  • Health economics
  • Managed care contracting
  • Healthcare payment models

Background:

  • Global fees represent an advanced risk-based contracting technique in managed care.
  • Current healthcare payment models often rely on less efficient fee-for-service or capitation structures.
  • Implementation of global fees faces significant challenges due to existing infrastructure.

Purpose of the Study:

  • To highlight the potential of global fees for episodes of care.
  • To identify the primary barriers to implementing global fee arrangements.
  • To discuss available billing techniques for episode of care contracting.

Main Methods:

  • Literature review of managed care contracting techniques.
  • Analysis of billing and claims transaction system limitations.

Related Experiment Videos

  • Discussion of alternative billing strategies for episode-based payments.

    • Main Results:

    • Global fees are theoretically superior to fee-for-service and capitation.
    • Archaic billing and claims systems are the main obstacle to global fee implementation.
    • Various billing techniques can facilitate entry into episode of care contracting.

    Conclusions:

    • Global fees offer a progressive, efficient payment model for episodes of care.
    • Modernizing billing and claims systems is crucial for adopting global fees.
    • Exploring alternative billing techniques is essential for successful episode of care contracting.