Global Payment Model of Reimbursement

Posted by mgsionline on August 26th, 2013

In the past few years, the US healthcare system is striving to enhance the quality of patient care at reduced healthcare costs. To accomplish this goal, it introduced several physician billing payment models that would replace the traditional Fee-for-Service model. Such healthcare reform models were specially designed to eliminate abuse and misuse of healthcare services and offer good-quality patient care. The Global Payment System is the recent buzz in the US healthcare domain, which has taken provider billing and patient care to a whole new level. Let’s take a look at the salient features of this provider billing payment model:

The Success Story: The Harvard University study on the 2009 Blue Cross Blue Shield of Massachusetts’ global payment initiative program acts as a solid proof to the success of this physician billing payment model. The results of this study clearly show that the quality of patient care has improved significantly. In addition, healthcare costs were lowered by 1.9% in the first year and by 3.3% the following year.

Salient Features:

• Contractual Payment: Under this medical insurance billing payment model, Healthcare Providers and Facilities will get reimbursed based on the services rendered to their patients in a specific time period, mostly a year.
• Fixed Budget: The Global Payment model is also known as the fixed-dollar payment model as the reimbursements are made based on a fixed budget predetermined by the Payer. 
• Impact: This physician billing payment model has avoided the use of unnecessary healthcare services. It has also encouraged the integration and coordination of services to a greater extent. Yet another important advantage worth mentioning is that Providers can enjoy great incentives on improving patient care exceptionally.
• Care Oriented: This model is purely patient care-oriented, so there is no way a Provider could withhold healthcare services, as the reimbursements and performance bonuses are directly linked with the results of the patient care provided. Providers can enjoy such benefits only when they show positive results to the Payer.
• Risks Involved: Although Providers enjoy a great deal of benefits under this provider billing payment model, they also share a huge amount of risk. They not only have to tackle the insurance risk, but also the medical risk involved. However, Providers must face this risk-sharing arrangement boldly by providing quality care and showing extraordinary results. If they succeed in doing so without exceeding the budget limit, then they can enjoy high profits.            

While Healthcare Providers and Facilities are having a tough time implementing and adapting to this new payment model, their medical billing and collection process has been affected hugely. To avoid further complications, they ought to outsource medical billing to a reputed company like MGSI.

About MGSI:

With over 20 years of experience, MGSI has been providing outstanding medical billing and collection services to its clients across the US. This Florida-based company can help Healthcare Providers and Facilities with medical insurance billing functions while they concentrate on Global Payment model implementation. For more details, log on to www.mgsionline.com