01369e17_Provider_Reimbursement_System___Setting_Methodology_Component
[Description] State can establish quality incentives (in line with the pay for performance methodology). As an example, the federal government is attempting to pay for quality measurement in the Medicare system. CMS Medicare will pay an additional 1.5% to physicians who report data on certain quality measures. CMS is focused on evidence-based quality measures such as how often physicians prescribe certain drugs. A similar program could be implemented for Medicaid rates.
Quality Incentives
F e e f o r S e r v i c e R a t e s
C o s t B a s e d R a t e s
R a t e S e t t l e m e n t P r o c e s s
P r o s p e c t i v e P a y m e n t R a t e s
M e d i c a r e R a t e s
P e r D i e m R a t e s
P a y f o r P e r f o r m a n c e
C a p i t a t e d R a t e s
Q u a l i t y I n c e n t i v e s
Provider Reimbursement System
Rate Setting Methodology/Component