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Retrospective payment is sometimes called "virtual bundling." [56] Approach to risk adjustment: bundled payments often use a risk adjustment approach to modify the price of the bundle to reflect the severity of the patient's condition. Payment methods vary on the basis of which factors are used to determine the risk adjustment (such a patient ...
Generally Accepted Accounting Principles (GAAP) [a] is the accounting standard adopted by the U.S. Securities and Exchange Commission (SEC), [1] and is the default accounting standard used by companies based in the United States.
In accounting, the revenue recognition principle states that revenues are earned and recognized when they are realized or realizable, no matter when cash is received. It is a cornerstone of accrual accounting together with the matching principle. Together, they determine the accounting period in which revenues and expenses are recognized. [1]
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [1]In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
Two types of balancing accounts exist to prevent fictitious profits and losses that might arise when cash is paid out in different accounting periods than when expenses are recognised. According to the matching principle in accrual accounting, expenses are recognised when obligations are incurred, regardless of when cash is paid. Cash can be ...
In 2000, CMS changed the reimbursement system for outpatient care at Federally Qualified Health Centers (FQHCs) to include a prospective payment system for Medicaid and Medicare. [2] Under this system, health centers receive a fixed, per-visit payment for any visit by a patient with Medicaid, regardless of the length or intensity of the visit.
There are certain advantages in tax planning when the cash method of accounting is used: for instance, payment of business expenses may be accelerated before year end, in order to maximize tax deductions, whereas billings for services may be postponed to after year end, so that payments won't be received until the new year, thus postponing tax ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...