Question

This is a two-part question worth a total of 20 points.

Part 1: Provider Payment (10 points)

Before we talk about the challenges, let's first define P4P. What does our text say about P4P? Discuss the challenges and benefits of pay for performance under managed care plans.

Part 2: Claims and Benefits (10 points)

What are the current challenges of claims capabilities, including ICD-10-CM?

Answer 1

Answer :

In health care setting ,pay For performance also known as 'value based purchasing ' is a payment model that offers financial incentives to physicians ,hospitals ,medical groups and other health care providers For meeting certain performance measures.

P4P programs are supported by insurance providers ,meficaid and medicare .

• Pay For performance plans are a method of compensation where workers are paid based on productivity ,as opposed to hours spent on the job or at a set salary . They are often used in field such as sales ,where workers rely on commisions and bonus For their income.

Benefits :

• Can align the interest of the payers and providers to deliver higher quality care .
• Performance bonuses can be invested in efforts to further improve quality.
• Can focus providers attension on meeting specific performance targets.

Challenges :

• Difficult to design programs to encourage intended behavior while preventing unintended behavior such as cheating and avoidance of high risk patients .
• May undermine health care professionals intrinsic motivation to provide high quality care.
• May fail to motivate system level changes to improve population health.

2) reimbursement challenges .

Most specificity is required by ICD 10 .

Limited flexibility regarding claims payment and quality reporting if level of specificity is not correct.

I CD -10 coding will be required by CMS For all diagnosis coding and all inpatient procedures For payment For all dates .

Work flow challenges associated with a change .

Clinical documentation issues ,how accurately clinical documentation captures the visit and the diagnosis will ultimately impact incentive payments.

Coorect codibg is very much important in the clinical documentation ,it will reflect the disease condition of particular patient .