The Beginning
There have been new trends affecting today’s payment methods for long term healthcare services which is making the United States Health Care system ever more complicated. Long term health care today is considered a reimbursement driven industry (Casto, 2006) . The term reimbursement refers to repayment or compensation of health care services (Bowman, 2007). Reimbursement is the process of being repaid for services that have already been given (Casto, 2006). In long term care, services are often provided prior to payment being made. Since patients have already received treatment, the facility, practitioners, and their staff seek reimbursement to cover those expenses such as medications, procedures, and supplies (Bowman, 2007).
Generally a physician, health care organization, or practitioner will submit an itemization of services, products, equipment, and supplies that have been rendered (Casto, 2006). This is known as a claim (Casto, 2006). The claim lists the fundamental characteristics of reimbursement such as fees and charges (Casto, 2006). These claims are reimbursed by one of two ways. An institution can be paid by a fixed amount called capitation (Casto, 2006). A capitated amount is what is paid regardless of the number or costs of health care services provided (Bowman, 2007). This often gives providers incentive to lower costs and to focus more on preventive care (Bowman, 2007). Fee for Service is another method of reimbursement. This is paid based on a set fee for each service provided (Casto, 2006). The set amount is based on what the payer deems as a normal charge for that service (Bowman, 2007). Fee for Service gives providers incentive to work harder and to provide a better quality of care that people want (Casto, 2006). In the situations facing the long term care industry, we need to realize that not all professionals are