As an outpatient provider, it is important to understand the various reimbursement models available. Knowing the options and their implications can save time when filing claims and ensure that you are getting the most out of your practice.
Dr Charles Noplis, who has been an Outpatient Provider at Seven Counties Services since January 2020 and Renew Recovery LLC from November 2016 to November 2019, provides a comprehensive overview of reimbursement models in this blog post.
Fee-For-Service Model
The fee-for-service (FFS) model is one of the most common reimbursement models used by outpatient providers. Under this model, services are billed separately for each procedure or visit provided to patients.
Providers are compensated directly for each service rendered, allowing them to make more money if they provide more services. This is ideal for physicians who perform high volumes of procedures or visits as they can earn more revenue than those on a fixed salary.
However, it also makes it difficult to track the cost of care since payment is made per service instead of per patient episode.
Revenue-Based Model
The revenue-based model compensates providers based on their total revenues rather than individual services performed. This model allows providers to receive larger payments for providing a bundle of services or multiple patient visits over a certain period of time instead of paying them per visit or procedure.
It also encourages cost savings since providers must manage their costs efficiently in order to maximize their profits from reimbursements received from payers.
Capitation Model
Under the capitation model, providers receive payments for caring for a certain number of patients regardless of how many services are actually provided during any given month or year. It also allows providers to focus on quality over quantity since they are no longer rewarded for providing more services but rather keeping their patients healthy and out of medical facilities as much as possible.
Conclusion:
Dr Charles Noplis With careful consideration, researching your options thoroughly, and understanding what works best for you as provider you can find the right reimbursement model that maximizes your profits while still delivering quality care to your patients!
