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Revenue Determination
Chapter 6

1- List and discuss the three payment determination bases.

Cost based: underlying method for payment will be the provider’s cost.
Fee Schedule – predetermined, unrelated to either provider's cost or price
Price related – provider will be paid for services based upon some relationship to its total charge or price for the services rendered.

2- What are the two usual units upon which payment is based in the three payment determination bases? What are the basic differences between these two types?

Specific services are based upon services provided
Bundled services are a fee schedule and there is no additional payment for ancillary services

3- How can a health care firm benefit from perceived higher levels of quality care when fixed payment payers comprise eighty percent (80%) of the firms revenue?

Increase volume on payers that leads to gain profit

Homework Assignment
Chapter 4

1- How could a hospital avoid being covered by the Emergency Medical Treatment and Active Labor Act? Identify and describe the key elements of the plan.

* Review and understand the EMTALA requirements * Ensure that all patients who leave the hospital without receiving treatment are offered a medical examination * Reasonable steps are taken to obtain patient’s informed consent to refuse the examination or treatment. * Emergency department staff have reviewed and understand all requirements regarding transfer of patients to another facility * Not ask the patient about his/her financial status or insurance.

2- Should hospitals and physicians under code Medicare patient stays and patient visits in order to reduce the possibility of being charged under the False Claims Act?

* The FCA is not intending to apply to honest mistakes and negligence. * It charges just the health care providers

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