Sample records for provider payment methods

  1. Provider payment in community-based health insurance schemes in developing countries: a systematic review

    PubMed Central

    Robyn, Paul Jacob; Sauerborn, Rainer; Bärnighausen, Till

    2013-01-01

    Objectives Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance. Methods We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010. Results Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme. Conclusion CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic. PMID:22522770

  2. Provider payment in community-based health insurance schemes in developing countries: a systematic review.

    PubMed

    Robyn, Paul Jacob; Sauerborn, Rainer; Bärnighausen, Till

    2013-03-01

    Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance. We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010. Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme. CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic.

  3. Incentives and provider payment methods.

    PubMed

    Barnum, H; Kutzin, J; Saxenian, H

    1995-01-01

    The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

  4. 10 CFR 603.805 - Payment methods.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Payment methods. 603.805 Section 603.805 Energy DEPARTMENT... Other Administrative Matters Payments § 603.805 Payment methods. A TIA may provide for: (a... progress. A fixed-support TIA must use this payment method (this does not preclude use of an initial...

  5. 10 CFR 603.805 - Payment methods.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Payment methods. 603.805 Section 603.805 Energy DEPARTMENT... Other Administrative Matters Payments § 603.805 Payment methods. A TIA may provide for: (a... progress. A fixed-support TIA must use this payment method (this does not preclude use of an initial...

  6. 10 CFR 603.805 - Payment methods.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Payment methods. 603.805 Section 603.805 Energy DEPARTMENT... Other Administrative Matters Payments § 603.805 Payment methods. A TIA may provide for: (a... progress. A fixed-support TIA must use this payment method (this does not preclude use of an initial...

  7. 10 CFR 603.805 - Payment methods.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Payment methods. 603.805 Section 603.805 Energy DEPARTMENT... Other Administrative Matters Payments § 603.805 Payment methods. A TIA may provide for: (a... progress. A fixed-support TIA must use this payment method (this does not preclude use of an initial...

  8. 10 CFR 603.805 - Payment methods.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Payment methods. 603.805 Section 603.805 Energy DEPARTMENT... Other Administrative Matters Payments § 603.805 Payment methods. A TIA may provide for: (a... progress. A fixed-support TIA must use this payment method (this does not preclude use of an initial...

  9. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach.

    PubMed

    Agyepong, Irene A; Aryeetey, Geneieve C; Nonvignon, Justice; Asenso-Boadi, Francis; Dzikunu, Helen; Antwi, Edward; Ankrah, Daniel; Adjei-Acquah, Charles; Esena, Reuben; Aikins, Moses; Arhinful, Daniel K

    2014-08-05

    Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects.

  10. 24 CFR 241.1050 - Method of loan payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Method of loan payment. 241.1050 Section 241.1050 Housing and Urban Development Regulations Relating to Housing and Urban Development...-Eligibility Requirements § 241.1050 Method of loan payment. The loan shall provide for monthly payments on the...

  11. 24 CFR 241.1050 - Method of loan payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Method of loan payment. 241.1050 Section 241.1050 Housing and Urban Development Regulations Relating to Housing and Urban Development...-Eligibility Requirements § 241.1050 Method of loan payment. The loan shall provide for monthly payments on the...

  12. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme – a systems approach

    PubMed Central

    2014-01-01

    Background Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. Methods A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. Results There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. Conclusions As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects. PMID:25096303

  13. Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives

    PubMed Central

    2014-01-01

    Background Performance measures are often neglected during the transition period of national health insurance scheme implementation in many low and middle income countries. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme using optimal resource use domains and examines possible factors that influence each domain, according to providers’ perspectives. Methods A retrospective, cross-sectional survey was done between August and December 2010 in Kaduna state, and 466 health care provider personnel were interviewed. Optimal-resource-use was defined in four domains: provider payment mechanism (capitation and fee-for-service payment methods), benefit package, administrative efficiency, and active monitoring mechanism. Logistic regression analysis was used to identify provider factors that may influence each domain. Results In the provider payment mechanism domain, capitation payment method (95%) performed better than fee-for-service payment method (62%). Benefit package domain performed strongly (97%), while active monitoring mechanism performed weakly (37%). In the administrative efficiency domain, both promptness of referral system (80%) and prompt arrival of funds (93%) performed well. At the individual level, providers with fewer enrolees encountered difficulties with reimbursement. Other factors significantly influenced each of the optimal-resource-use domains. Conclusions Fee-for-service payment method and claims review, in the provider payment and active monitoring mechanisms, respectively, performed weakly according to the providers’ (at individual-level) perspectives. A short-fall on the supply-side of health insurance could lead to a direct or indirect adverse effect on the demand-side of the scheme. Capitation payment per enrolees should be revised to conform to economic circumstances. Performance indicators and providers’ characteristics and experiences associated with resource use can assist policy makers to monitor and evaluate health insurance implementation. PMID:24628889

  14. Provider payment methods and health worker motivation in community-based health insurance: a mixed-methods study.

    PubMed

    Robyn, Paul Jacob; Bärnighausen, Till; Souares, Aurélia; Traoré, Adama; Bicaba, Brice; Sié, Ali; Sauerborn, Rainer

    2014-05-01

    In a community-based health insurance (CBHI) introduced in 2004 in Nouna health district, Burkina Faso, poor perceived quality of care by CBHI enrollees has been a key factor in observed high drop-out rates. The poor quality perceptions have been previously attributed to health worker dissatisfaction with the provider payment method used by the scheme and the resulting financial risk of health centers. This study applied a mixed-methods approach to investigate how health workers working in facilities contracted by the CBHI view the methods of provider payment used by the CBHI. In order to analyze these relationships, we conducted 23 in-depth interviews and a quantitative survey with 98 health workers working in the CBHI intervention zone. The qualitative in-depth interviews identified that insufficient levels of capitation payments, the infrequent schedule of capitation payment, and lack of a payment mechanism for reimbursing service fees were perceived as significant sources of health worker dissatisfaction and loss of work-related motivation. Combining qualitative interview and quantitative survey data in a mixed-methods analysis, this study identified that the declining quality of care due to the CBHI provider payment method was a source of significant professional stress and role strain for health workers. Health workers felt that the following five changes due to the provider payment methods introduced by the CBHI impeded their ability to fulfill professional roles and responsibilities: (i) increased financial volatility of health facilities, (ii) dissatisfaction with eligible costs to be covered by capitation; (iii) increased pharmacy stock-outs; (iv) limited financial and material support from the CBHI; and (v) the lack of mechanisms to increase provider motivation to support the CBHI. To address these challenges and improve CBHI uptake and health outcomes in the targeted populations, the health care financing and delivery model in the study zone should be reformed. We discuss concrete options for reform based on the study findings. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China.

    PubMed

    Zhao, Cuirong; Wang, Chao; Shen, Chengwu; Wang, Qian

    2018-05-13

    Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative. This article briefly describes the DRG-based case-mix payment system, it comparatively analyzes differences between FFS and case-mix funding systems, and it describes the implementation of DRGs in China. China's social and economic conditions differ across regions, so establishment of a national payment standard will take time and involve difficulties. No single method of provider payment is perfect. Measures to monitor and minimize the negative ethical implications and unintended effects of a DRG-based case-mix payment system are essential to ensuring the lasting social benefits of payment reform in Chinese public hospitals.

  16. Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

    PubMed

    Ginsburg, Paul B

    2012-09-01

    Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

  17. The impact of physician payment methods on raising the efficiency of the healthcare system: an international comparison.

    PubMed

    Simoens, Steven; Giuffrida, Antonio

    2004-01-01

    This article reviews policies on physician payment methods that Organisation for Economic Cooperation and Development (OECD) countries have implemented to promote an efficient deployment of physicians. Countries' experiences show that payment by fee-for-service, capitation and salary influences physician activity levels and productivity. However, the impact of these simple payment methods is complex and may be diluted by clinical, demographic, ethical and organisational factors. Policies that have attempted to curb health expenditure by controlling fee levels have sometimes been eroded by physicians increasing the volume of service supply, or providing services that attract higher fees. Flexible blended payment methods based on the combination of a fixed component, through either capitation or salary, and a variable component, through fee-for-service, may produce a desirable mix of incentives. Integrating such blended payment methods with mechanisms to monitor physician activity may offer potential success.

  18. Medicare payments to the neurology workforce in 2012

    PubMed Central

    Skolarus, Lesli E.; Burke, James F.; Callaghan, Brian C.; Becker, Amanda

    2015-01-01

    Objective: Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Methods: Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Results: Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%–51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. Conclusion: E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. PMID:25832665

  19. Hospital non-price competition under the Global Budget Payment and Prospective Payment Systems.

    PubMed

    Chen, Wen-Yi; Lin, Yu-Hui

    2008-06-01

    This paper provides theoretical analyses of two alternative hospital payment systems for controlling medical cost: the Global Budget Payment System (GBPS) and the Prospective Payment System (PPS). The former method assigns a fixed total budget for all healthcare services over a given period with hospitals being paid on a fee-for-service basis. The latter method is usually connected with a fixed payment to hospitals within a Diagnosis-Related Group. Our results demonstrate that, given the same expenditure, the GBPS would approach optimal levels of quality and efficiency as well as the level of social welfare provided by the PPS, as long as market competition is sufficiently high; our results also demonstrate that the treadmill effect, modeling an inverse relationship between price and quantity under the GBPS, would be a quality-enhancing and efficiency-improving outcome due to market competition.

  20. Informal payments and the financing of health care in developing and transition countries.

    PubMed

    Lewis, Maureen

    2007-01-01

    Informal, under-the-table payments to public health care providers are increasingly viewed as a critically important source of health care financing in developing and transition countries. With minimal funding levels and limited accountability, publicly financed and delivered care falls prey to illegal payments, which require payments that can exceed 100 percent of a country's median income. Methods to address the abuse include establishing official fees, combined with improved oversight and accountability for public health care providers, and a role for communities in holding providers accountable.

  1. 34 CFR 668.162 - Requesting funds.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) General. (1) The Secretary has sole discretion to determine the method under which the Secretary provides..., or cash monitoring payment methods. (2) Each time an institution requests funds from the Secretary... that the Secretary assigned to the authorization for those funds. (b) Advance payment method. Under the...

  2. 34 CFR 668.162 - Requesting funds.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) General. (1) The Secretary has sole discretion to determine the method under which the Secretary provides..., or cash monitoring payment methods. (2) Each time an institution requests funds from the Secretary... that the Secretary assigned to the authorization for those funds. (b) Advance payment method. Under the...

  3. 34 CFR 668.162 - Requesting funds.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) General. (1) The Secretary has sole discretion to determine the method under which the Secretary provides..., or cash monitoring payment methods. (2) Each time an institution requests funds from the Secretary... that the Secretary assigned to the authorization for those funds. (b) Advance payment method. Under the...

  4. 34 CFR 668.162 - Requesting funds.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) General. (1) The Secretary has sole discretion to determine the method under which the Secretary provides..., or cash monitoring payment methods. (2) Each time an institution requests funds from the Secretary... that the Secretary assigned to the authorization for those funds. (b) Advance payment method. Under the...

  5. 34 CFR 668.162 - Requesting funds.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) General. (1) The Secretary has sole discretion to determine the method under which the Secretary provides..., or cash monitoring payment methods. (2) Each time an institution requests funds from the Secretary... that the Secretary assigned to the authorization for those funds. (b) Advance payment method. Under the...

  6. 27 CFR 25.163 - Method of tax payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., DEPARTMENT OF THE TREASURY LIQUORS BEER Tax on Beer Preparation and Remittance of Tax Returns § 25.163 Method of tax payment. A brewer shall pay the tax on beer by return on Form 5000.24, as provided in §§ 25...

  7. 27 CFR 25.163 - Method of tax payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., DEPARTMENT OF THE TREASURY LIQUORS BEER Tax on Beer Preparation and Remittance of Tax Returns § 25.163 Method of tax payment. A brewer shall pay the tax on beer by return on TTB F 5000.24, as provided in §§ 25...

  8. 27 CFR 25.163 - Method of tax payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., DEPARTMENT OF THE TREASURY ALCOHOL BEER Tax on Beer Preparation and Remittance of Tax Returns § 25.163 Method of tax payment. A brewer shall pay the tax on beer by return on TTB F 5000.24, as provided in §§ 25...

  9. 27 CFR 25.163 - Method of tax payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF THE TREASURY LIQUORS BEER Tax on Beer Preparation and Remittance of Tax Returns § 25.163 Method of tax payment. A brewer shall pay the tax on beer by return on TTB F 5000.24, as provided in §§ 25...

  10. Comparison of cost accounting methods from different DRG systems and their effect on health care quality.

    PubMed

    Leister, Jan Eric; Stausberg, Jürgen

    2005-09-28

    Diagnosis related groups (DRGs) are a well-established provider payment system. Because of their imminent potential of cost reduction, they have been widely introduced. In addition to cost cutting, several social objectives - e.g., improving overall health care quality - feed into the DRG system. The WHO compared different provider payment systems with regard to the following objectives: prevention of further health problems, providing services and solving health problems, and responsiveness to people's legitimate expectations. However, no study has been published which takes the impact of different cost accounting systems across the DRG systems into account. We compared the impact of different cost accounting methods within DRG-like systems by developing six criteria: integration of patients' health risk into pricing practice, incentives for quality improvement and innovation, availability of high class evidence based therapy, prohibition of economically founded exclusions, reduction of fragmentation incentives, and improvement of patient oriented treatment. We set up a first overview of potential and actual impacts of the pricing practices within Yale-DRGs, AR-DRGs, G-DRGs, Swiss AP-DRGs adoption and Swiss MIPP. It could be demonstrated that DRGs are not only a 'homogenous' group of similar provider payment systems but quite different by fulfilling major health care objectives connected with the used cost accounting methods. If not only the possible cost reduction is used to put in a good word for DRG-based provider payment systems, maximum accurateness concerning the method of cost accounting should prevail when implementing a new DRG-based provider payment system.

  11. 5 CFR 1653.5 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... letter. This is intended to permit the payee sufficient time to consider decisions about tax withholding... time. A series of payments will not be made, even if the court order provides for such a method of.... (k) If a court ordered payment is returned as undeliverable, the TSP record keeper will attempt to...

  12. 14 CFR 1274.931 - Electronic funds transfer payment methods.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... institution or to provide appropriate payee bank account information may delay payments of amounts otherwise..., the Recipient shall provide the following information: (1) Name, address, and telegraphic abbreviation... access to the Federal Reserve Communication System. (3) Payee's account number at the financial...

  13. 42 CFR 447.205 - Public notice of changes in Statewide methods and standards for setting payment rates.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Public notice of changes in Statewide methods and... SERVICES Payment Methods: General Provisions § 447.205 Public notice of changes in Statewide methods and... this section, the agency must provide public notice of any significant proposed change in its methods...

  14. 42 CFR 447.205 - Public notice of changes in Statewide methods and standards for setting payment rates.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Public notice of changes in Statewide methods and... SERVICES Payment Methods: General Provisions § 447.205 Public notice of changes in Statewide methods and... this section, the agency must provide public notice of any significant proposed change in its methods...

  15. Physician Payment Methods and the Patient-Centered Medical Home: Comment on "A Troubled Asset Relief Program for the Patient-Centered Medical Home".

    PubMed

    Quinn, Kevin

    This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk. Episode payment may strike a feasible balance for PCMHs, with newly available episode definitions presenting opportunities not previously available.

  16. A simple simulation model as a tool to assess alternative health care provider payment reform options in Vietnam.

    PubMed

    Cashin, Cheryl; Phuong, Nguyen Khanh; Shain, Ryan; Oanh, Tran Thi Mai; Thuy, Nguyen Thi

    2015-01-01

    Vietnam is currently considering a revision of its 2008 Health Insurance Law, including the regulation of provider payment methods. This study uses a simple spreadsheet-based, micro-simulation model to analyse the potential impacts of different provider payment reform scenarios on resource allocation across health care providers in three provinces in Vietnam, as well as on the total expenditure of the provincial branches of the public health insurance agency (Provincial Social Security [PSS]). The results show that currently more than 50% of PSS spending is concentrated at the provincial level with less than half at the district level. There is also a high degree of financial risk on district hospitals with the current fund-holding arrangement. Results of the simulation model show that several alternative scenarios for provider payment reform could improve the current payment system by reducing the high financial risk currently borne by district hospitals without dramatically shifting the current level and distribution of PSS expenditure. The results of the simulation analysis provided an empirical basis for health policy-makers in Vietnam to assess different provider payment reform options and make decisions about new models to support health system objectives.

  17. Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission.

    PubMed

    Jian, Weiyan; Lu, Ming; Chan, Kit Yee; Poon, Adrienne N; Han, Wei; Hu, Mu; Yip, Winnie

    2015-10-01

    In 2009 China announced plans to reform provider payment methods at public hospitals by moving from fee-for-service (FFS) to prospective and aggregated payment methods that included the use of diagnosis-related groups (DRGs) to control health expenditures. In October 2011 health policy makers selected six Beijing hospitals to pioneer the first DRG payment system in China. We used hospital discharge data from the six pilot hospitals and eight other hospitals, which continued to use FFS and served as controls, from the period 2010-12 to evaluate the pilot's impact on cost containment through a difference-in-differences methods design. Our study found that DRG payment led to reductions of 6.2 percent and 10.5 percent, respectively, in health expenditures and out-of-pocket payments by patients per hospital admission. We did not find evidence of any increase in hospital readmission rates or cost shifting from cases eligible for DRG payment to ineligible cases. However, hospitals continued to use FFS payments for patients who were older and had more complications than other patients, which reduced the effectiveness of payment reform. Continuous evidence-based monitoring and evaluation linked with adequate management systems are necessary to enable China and other low- and middle-income countries to broadly implement DRGs and refine payment systems. Project HOPE—The People-to-People Health Foundation, Inc.

  18. Medicaid payment policies for nursing home care: A national survey

    PubMed Central

    Buchanan, Robert J.; Madel, R. Peter; Persons, Dan

    1991-01-01

    This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access. PMID:10114935

  19. A systematic review of empirical studies on methodology and burden of informal patient payments in health systems.

    PubMed

    Khodamoradi, Abdolvahed; Ghaffari, Mohammad Payam; Daryabeygi-Khotbehsara, Reza; Sajadi, Haniye Sadat; Majdzadeh, Reza

    2018-01-01

    Informal patients' payments (IPPs) is a sensitive subject. The aim of current study was to assess the trends in informal payment studies and explore methods of IPPs measurement, prevalence, and features (payment type, volume, and receiver) in various contexts. A search strategy was developed to identify peer-reviewed articles addressing informal payments on PubMed, Science Direct, Web of Science, Scopus, and CINAHL. A total of 1252 studies were identified initially. After screening process, 38 studies were included in the systematic review. The selected studies were appraised, and findings were synthesized. Among selected studies, quantitative approaches were mostly used for measuring IPPs from general public and patients' perspective, and qualitative methods mainly targeted health care providers. Reported IPP prevalence in selected articles ranges between 2% and 80%, more prevalent in the inpatient sector than in outpatient. There are a number of strategies for the measurement of IPPs with different strengths and weaknesses. Most applied strategies for general public were quantitative surveys recruiting more than 1000 participants using a face-to-face structured interview, and then qualitative studies on less than 150 health care providers, with focus group discussion. This review provides a comprehensive picture of current informal patients' payments measurement tools, which helps researchers in future investigations. Copyright © 2017 John Wiley & Sons, Ltd.

  20. Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments

    PubMed Central

    2010-01-01

    Background Empirical evidence demonstrates that informal patient payments are an important feature of many health care systems. However, the study of these payments is a challenging task because of their potentially illegal and sensitive nature. The aim of this paper is to provide a systematic review and analysis of key methodological difficulties in measuring informal patient payments. Methods The systematic review was based on the following eligibility criteria: English language publications that reported on empirical studies measuring informal patient payments. There were no limitations with regard to the year of publication. The content of the publications was analysed qualitatively and the results were organised in the form of tables. Data sources were Econlit, Econpapers, Medline, PubMed, ScienceDirect, SocINDEX. Results Informal payments for health care services are most often investigated in studies involving patients or the general public, but providers and officials are also sample units in some studies. The majority of the studies apply a single mode of data collection that involves either face-to-face interviews or group discussions. One of the main methodological difficulties reported in the publication concerns the inability of some respondents to distinguish between official and unofficial payments. Another complication is associated with the refusal of some respondents to answer questions on informal patient payments. We do not exclude the possibility that we have missed studies that reported in non-English language journals as well as very recent studies that are not yet published. Conclusions Given the recent evidence from research on survey methods, a self-administrated questionnaire during a face-to-face interview could be a suitable mode of collecting sensitive data, such as data on informal patient payments. PMID:20849658

  1. 75 FR 80854 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-23

    ..., ``Financial EDI Authorization''; NUREG/BR-0254, Payment Methods; and NRC Form 629, ``Authorization for Payment... licensing fees, and inspection fees to the NRC. The NRC Form 628, ``Financial EDI Authorization,'' provides...

  2. Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?

    PubMed Central

    Carrin, Guy; Hanvoravongchai, Piya

    2003-01-01

    In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries. First, a schematic view of the main cost-containment methods and the variables in the health system they intend to influence is presented. Two types of instruments to control the level and growth of public health expenditure are considered: (i) provider payment methods that influence the price and quantity of health care, and (ii) cost-containment measures that influence the behaviour of patients. Belonging to the first type of instruments, we have: fee-for-service, per diem payment, case payment, capitation, salaries and budgets. The second type of instruments consists of patient charges and reference price systems for pharmaceuticals. Secondly, we provide an overview of experience in high-income countries that use or have used these particular instruments. Finally, the paper assesses the overall potential of these instruments in cost-containment policies. PMID:12914661

  3. The effects of medical group practice and physician payment methods on costs of care.

    PubMed Central

    Kralewski, J E; Rich, E C; Feldman, R; Dowd, B E; Bernhardt, T; Johnson, C; Gold, W

    2000-01-01

    OBJECTIVE: To assess the effects of payment methods on the costs of care in medical group practices. DATA SOURCES: Eighty-six clinics providing services for a Blue Cross managed care program during 1995. The clinics were analyzed to determine the relationship between payment methods and cost of care. Cost and patient data were obtained from Blue Cross records, and medical group practice clinic data were obtained by a survey of those organizations. STUDY DESIGN: The effects of clinic and physician payment methods on per member per year (PMPY) adjusted patient costs are evaluated using a two-stage regression model. Patient costs are adjusted for differences in payment schedules; patient age, gender, and ACG; clinic organizational variables are included as explanatory variables. DATA COLLECTION: Patient cost data were extracted from Blue Cross claims files, and patient and physician data from their enrollee and provider data banks. Medical group practice data were obtained by a mailed survey with telephone follow-up. PRINCIPAL FINDINGS: Capitation payment is correlated with lower patient care costs. When combined with fee-for-service with withhold provisions, this effect is smaller indicating that these two clinic payment methods are not interchangeable. Clinics with more physician compensation based on measures of resource use or based on some share of the net revenue of the clinic have lower patient care costs than those with more compensation related to productivity or based on salary. Salary compensation is strongly associated with higher costs. The use of physician profiles and clinical guidelines is associated with lower costs, but referral management systems have no such effect. The lower cost clinics are the smaller, multispecialty clinics. CONCLUSIONS: This study indicates that payment methods at both the medical group practice and physician levels influence the cost of care. However, the methods by which that influence is manifest is not clear. Although the organizational structure of clinics and their use of managed care programs appear to play a role, this influence is less than expected. PMID:10966087

  4. Payment methods for outpatient care facilities

    PubMed Central

    Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

    2017-01-01

    Background Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. Objectives To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Selection criteria Randomised trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for outpatient health facilities. We defined outpatient care facilities in this review as facilities that provide health services to individuals who do not require hospitalisation or institutionalisation. We only included methods used to transfer funds from the purchaser of healthcare services to health facilities (including groups of individual professionals). These include global budgets, line-item budgets, capitation, fee-for-service (fixed and unconstrained), pay for performance, and mixed payment. The primary outcomes were service provision outcomes, patient outcomes, healthcare provider outcomes, costs for providers, and any adverse effects. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We conducted a structured synthesis. We first categorised the comparisons and outcomes and then described the effects of different types of payment methods on different categories of outcomes. We used a fixed-effect model for meta-analysis within a study if a study included more than one indicator in the same category of outcomes. We used a random-effects model for meta-analysis across studies. If the data for meta-analysis were not available in some studies, we calculated the median and interquartile range. We reported the risk ratio (RR) for dichotomous outcomes and the relative change for continuous outcomes. Main results We included 21 studies from Afghanistan, Burundi, China, Democratic Republic of Congo, Rwanda, Tanzania, the United Kingdom, and the United States of health facilities providing primary health care and mental health care. There were three kinds of payment comparisons. 1) Pay for performance (P4P) combined with some existing payment method (capitation or different kinds of input-based payment) compared to the existing payment method We included 18 studies in this comparison, however we did not include five studies in the effects analysis due to high risk of bias. From the 13 studies, we found that the extra P4P incentives probably slightly improved the health professionals' use of some tests and treatments (adjusted RR median = 1.095, range 1.01 to 1.17; moderate-certainty evidence), and probably led to little or no difference in adherence to quality assurance criteria (adjusted percentage change median = -1.345%, range -8.49% to 5.8%; moderate-certainty evidence). We also found that P4P incentives may have led to little or no difference in patients' utilisation of health services (adjusted RR median = 1.01, range 0.96 to 1.15; low-certainty evidence) and may have led to little or no difference in the control of blood pressure or cholesterol (adjusted RR = 1.01, range 0.98 to 1.04; low-certainty evidence). 2) Capitation combined with P4P compared to fee-for-service (FFS) One study found that compared with FFS, a capitated budget combined with payment based on providers' performance on antibiotic prescriptions and patient satisfaction probably slightly reduced antibiotic prescriptions in primary health facilities (adjusted RR 0.84, 95% confidence interval 0.74 to 0.96; moderate-certainty evidence). 3) Capitation compared to FFS Two studies compared capitation to FFS in mental health centres in the United States. Based on these studies, the effects of capitation compared to FFS on the utilisation and costs of services were uncertain (very low-certainty evidence). Authors' conclusions Our review found that if policymakers intend to apply P4P incentives to pay health facilities providing outpatient services, this intervention will probably lead to a slight improvement in health professionals' use of tests or treatments, particularly for chronic diseases. However, it may lead to little or no improvement in patients' utilisation of health services or health outcomes. When considering using P4P to improve the performance of health facilities, policymakers should carefully consider each component of their P4P design, including the choice of performance measures, the performance target, payment frequency, if there will be additional funding, whether the payment level is sufficient to change the behaviours of health providers, and whether the payment to facilities will be allocated to individual professionals. Unfortunately, the studies included in this review did not help to inform those considerations. Well-designed comparisons of different payment methods for outpatient health facilities in low- and middle-income countries and studies directly comparing different designs (e.g. different payment levels) of the same payment method (e.g. P4P or FFS) are needed. Payment methods for outpatient care facilities Review aim The aim of this Cochrane review was to assess the effect of different payment systems for outpatient care facilities. We collected and analysed all relevant studies to answer this question and included 21 studies. Key messages Pay-for-performance systems probably have only small benefits or make little or no difference to healthcare provider behaviour or patients' use of healthcare services. We are uncertain whether they cause harm. We are uncertain about the benefits and harms of other payments systems because the research is lacking or of very low certainty. What was studied in the review? Many healthcare services are offered to patients through outpatient facilities rather than to inpatients in hospitals. Outpatient facilities are also known as ambulatory care facilities, and include primary healthcare centres, outpatient clinics, urgent care centres, family planning centres, mental health centres, and dental clinics. Different systems to reimburse outpatient (ambulatory) care facilities for their services are available to governments and health insurers. These systems include: • budget systems, where the facility is given a fixed amount of money in advance to cover expenses for a fixed period; • capitation payment systems, where the facility is paid a fixed amount of money in advance to provide specific services to each enrolled patient for a fixed period; • fee-for-service systems, where payment is based on the specific services that the healthcare facility provides; • pay-for-performance systems, where payment is partly based on the performance of the facility's healthcare providers. Different payment systems can have different effects on how healthcare facilities deliver care. These changes can be intentional or unintentional and can lead to both benefits and harms. At best, a payment system can encourage healthcare providers to offer the right healthcare services to the right patients in the best and most cost-efficient way. However, payment systems can also lead providers to offer poor-quality, expensive, and unnecessary care, which can ultimately have a negative impact on patients' health. This Cochrane review assessed the effect of different payment systems for outpatient care facilities. Other Cochrane reviews have assessed the effect of different payment systems for individual healthcare professionals and for inpatient facilities. Main results We found 21 relevant studies from the United Kingdom, the United States, Rwanda, Burundi, Tanzania, Afghanistan, China, and Democratic Republic of Congo. Most of the studies were from primary healthcare facilities. The studies assessed capitation systems, fee-for-service systems, and different types of pay-for-performance systems. Pay-for-performance systems: • probably slightly improve providers' use of some tests and treatments; • probably lead to little or no difference in providers' compliance with quality assurance criteria; • may lead to little or no difference in patients' use of health services; • may lead to little or no difference in patients' health status. Capitation combined with a pay-for-performance system targeted at reducing antibiotic use probably slightly reduces antibiotic prescriptions when compared to a fee-for-service system. Two studies compared capitation with fee-for-service systems, however, we assessed the certainty of the evidence as very low. We did not find any relevant studies that assessed budget systems. How up-to-date is this review? We searched for studies that had been published up to March 2016. PMID:28253540

  5. Payment methods for outpatient care facilities.

    PubMed

    Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

    2017-03-03

    Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Randomised trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for outpatient health facilities. We defined outpatient care facilities in this review as facilities that provide health services to individuals who do not require hospitalisation or institutionalisation. We only included methods used to transfer funds from the purchaser of healthcare services to health facilities (including groups of individual professionals). These include global budgets, line-item budgets, capitation, fee-for-service (fixed and unconstrained), pay for performance, and mixed payment. The primary outcomes were service provision outcomes, patient outcomes, healthcare provider outcomes, costs for providers, and any adverse effects. At least two review authors independently extracted data and assessed the risk of bias. We conducted a structured synthesis. We first categorised the comparisons and outcomes and then described the effects of different types of payment methods on different categories of outcomes. We used a fixed-effect model for meta-analysis within a study if a study included more than one indicator in the same category of outcomes. We used a random-effects model for meta-analysis across studies. If the data for meta-analysis were not available in some studies, we calculated the median and interquartile range. We reported the risk ratio (RR) for dichotomous outcomes and the relative change for continuous outcomes. We included 21 studies from Afghanistan, Burundi, China, Democratic Republic of Congo, Rwanda, Tanzania, the United Kingdom, and the United States of health facilities providing primary health care and mental health care. There were three kinds of payment comparisons. 1) Pay for performance (P4P) combined with some existing payment method (capitation or different kinds of input-based payment) compared to the existing payment methodWe included 18 studies in this comparison, however we did not include five studies in the effects analysis due to high risk of bias. From the 13 studies, we found that the extra P4P incentives probably slightly improved the health professionals' use of some tests and treatments (adjusted RR median = 1.095, range 1.01 to 1.17; moderate-certainty evidence), and probably led to little or no difference in adherence to quality assurance criteria (adjusted percentage change median = -1.345%, range -8.49% to 5.8%; moderate-certainty evidence). We also found that P4P incentives may have led to little or no difference in patients' utilisation of health services (adjusted RR median = 1.01, range 0.96 to 1.15; low-certainty evidence) and may have led to little or no difference in the control of blood pressure or cholesterol (adjusted RR = 1.01, range 0.98 to 1.04; low-certainty evidence). 2) Capitation combined with P4P compared to fee-for-service (FFS)One study found that compared with FFS, a capitated budget combined with payment based on providers' performance on antibiotic prescriptions and patient satisfaction probably slightly reduced antibiotic prescriptions in primary health facilities (adjusted RR 0.84, 95% confidence interval 0.74 to 0.96; moderate-certainty evidence). 3) Capitation compared to FFSTwo studies compared capitation to FFS in mental health centres in the United States. Based on these studies, the effects of capitation compared to FFS on the utilisation and costs of services were uncertain (very low-certainty evidence). Our review found that if policymakers intend to apply P4P incentives to pay health facilities providing outpatient services, this intervention will probably lead to a slight improvement in health professionals' use of tests or treatments, particularly for chronic diseases. However, it may lead to little or no improvement in patients' utilisation of health services or health outcomes. When considering using P4P to improve the performance of health facilities, policymakers should carefully consider each component of their P4P design, including the choice of performance measures, the performance target, payment frequency, if there will be additional funding, whether the payment level is sufficient to change the behaviours of health providers, and whether the payment to facilities will be allocated to individual professionals. Unfortunately, the studies included in this review did not help to inform those considerations.Well-designed comparisons of different payment methods for outpatient health facilities in low- and middle-income countries and studies directly comparing different designs (e.g. different payment levels) of the same payment method (e.g. P4P or FFS) are needed.

  6. 31 CFR 256.11 - How do agencies request payments?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... forms or by using other approved methods as provided for on the Judgment Fund Web site at http://www.fms.treas.gov/judgefund. FMS provides forms and detailed information about Judgment Fund payments in the TFM, Volume I, Part 6, Chapter 3100. The TFM is also available on the Judgment Fund Web site. The submitting...

  7. 31 CFR 256.11 - How do agencies request payments?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... forms or by using other approved methods as provided for on the Judgment Fund Web site at http://www.fms.treas.gov/judgefund. FMS provides forms and detailed information about Judgment Fund payments in the TFM, Volume I, Part 6, Chapter 3100. The TFM is also available on the Judgment Fund Web site. The submitting...

  8. 31 CFR 256.11 - How do agencies request payments?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... forms or by using other approved methods as provided for on the Judgment Fund Web site at http://www.fms.treas.gov/judgefund. FMS provides forms and detailed information about Judgment Fund payments in the TFM, Volume I, Part 6, Chapter 3100. The TFM is also available on the Judgment Fund Web site. The submitting...

  9. A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries.

    PubMed

    Andoh-Adjei, Francis-Xavier; Spaan, Ernst; Asante, Felix A; Mensah, Sylvester A; van der Velden, Koos

    2016-12-01

    To analyse and synthesize available international experiences and information on the motivation for, and effects of using capitation as provider payment method in country health systems and lessons and implications for low/middle-income countries. We did narrative review and synthesis of the literature on the effects of capitation payment on primary care. Eleven articles were reviewed. Capitation payment encourages efficiency: drives down cost, serves as critical source of income for providers, promotes adherence to guidelines and policies, encourages providers to work better and give health education to patients. It, however, induces reduction in the quantity and quality of care provided and encourages skimming on inputs, underserving of patients in bad state of health, "dumping" of high risk patients and negatively affect patient-provider relationship. The illustrative evidence adduced from the review demonstrates that capitation payment in primary care can create positive incentives but could also elicit un-intended effects. However, due to differences in country context, policy makers in Ghana and other low/middle-income countries may only be guided by the illustrative evidence in their design of a context-specific capitation payment for primary care. Netherlands Fellowship Programme (NFP), Fellowship number: NFP-PhD.12/352.

  10. The Physician Payments Sunshine Act: Data Evaluation Regarding Payments to Ophthalmologists

    PubMed Central

    Chang, Jonathan S.

    2014-01-01

    Objective/Purpose To review data for ophthalmologists published online from the Physician Payments Sunshine Act. Design Retrospective data review using a publicly available electronic database Methods: Main Outcome Measures A database was downloaded from the Centers for Medicare and Medicaid Services (CMS) Website under Identified General Payments to Physicians and a primary specialty of ophthalmology. Basic statistical analysis was performed including mean, median and range of payments for both single payments and per provider. Data were also summarized by category of payment, geographic region and compared with other surgical subspecialties. Results From August 1, 2013 to December 31, 2013, a total of 55,996 individual payments were reported to 9,855 ophthalmologists for a total of $10,926,447. The mean amount received in a single payment was $195.13 (range $0.04–$193,073). The mean amount received per physician ID was $1,108 (range $1–$397,849) and median amount $112.01. Consulting fees made up the largest percentage of fees. There was not a large difference in payments received by region. The mean payments for the subspecialties of dermatology, neurosurgery, orthopedic surgery and urology ranged from $954–$6,980, and median payments in each field by provider identifier ranged from $88–$173. Conclusions A large amount of data was released by CMS for the Physician Payment Sunshine Act. In ophthalmology, mean and median payments per physician did not vary greatly from other surgical subspecialties. Most single payments were under $100, and most physicians received less than $500 in total payments. Payments for consulting made up the largest category of spending. How this affects patient perception, patient care and medical costs warrants further study. PMID:25578254

  11. A risk-based prospective payment system that integrates patient, hospital and national costs.

    PubMed

    Siegel, C; Jones, K; Laska, E; Meisner, M; Lin, S

    1992-05-01

    We suggest that a desirable form for prospective payment for inpatient care is hospital average cost plus a linear combination of individual patient and national average cost. When the coefficients are chosen to minimize mean squared error loss between payment and costs, the payment has efficiency and access incentives. The coefficient multiplying patient costs is a hospital specific measure of financial risk of the patient. Access is promoted since providers receive higher reimbursements for risky, high cost patients. Historical cost data can be used to obtain estimates of payment parameters. The method is applied to Medicare data on psychiatric inpatients.

  12. Trends in US malpractice payments in dentistry compared to other health professions - dentistry payments increase, others fall.

    PubMed

    Nalliah, R P

    2017-01-13

    Background Little is known about trends in the number of malpractice payments made against dentists and other health professionals. Knowledge of these trends will inform the work of our professional organisations.Methods The National Practitioner Data Bank (NPDB) in the United States was utilised. Data about malpractice payments against dentists, hygienists, nurses, optometrists, pharmacists, physicians (DO and MD), physicians' assistants, podiatrists, psychologists, therapists and counsellors during 2004-14 were studied. Variables include type of healthcare provider, year malpractice payment was made and range of payment amount.Results In 2004 there were 17,532 malpractice payments against the studied health professions. In 2014 there were 11,650. In 2004, the number of malpractice payments against dentists represented 10.3% of all payments and in 2014 it represented 13.4%. Number of malpractice payments against dentists in 2012-2014 increased from 1,388 to 1,555.Conclusions There is an upward pressure on the number of dental malpractice payments over the last 3 years. Concurrently, there is a downward pressure on the number of combined non-dentist healthcare professional malpractice payments.

  13. Medicare Part D payments for neurologist-prescribed drugs

    PubMed Central

    Burke, James F.; Kerber, Kevin A.; Skolarus, Lesli E.; Callaghan, Brian C.

    2016-01-01

    Objective: To describe neurologists' Medicare Part D prescribing patterns and the potential effect of generic substitutions and price negotiation, which is currently prohibited. Methods: The 2013 Medicare Part D Prescriber Public Use and Summary files were used. Payments for medications were aggregated by provider and drug (brand or generic). Payment, proportion of generic claims or day's supply, and median payment per monthly supply of medication were calculated by physician specialty and drug. Savings from generic substitution were estimated for brand drugs with a generic available. Medicare prices were compared to drug prices negotiated by the federal government with pharmaceutical manufacturers for the Veterans Administration (VA). Results: Neurologists comprised 13,060 (1.2%) providers with $5.0 billion (4.8%) in total payments, third highest of all specialties, with a median monthly payment of $141 (interquartile range $85–225). Multiple sclerosis drugs had the highest payments ($1.8 billion). Within neurologic disease groups ($3.4 billion in payments), 54.2%–91.8% of monthly supplies were generic, but 11.9%–71.3% of the payment was for generic medications. Generic substitution resulted in a $269 million (6.5%) payment decrease. VA pricing resulted in $1.5 billion (44.5% of $3.4 billion) in savings. Conclusions: High payment per monthly supply of medication underlies the high total neurology drug payments and is driven by multiple sclerosis drugs. Lowering drug expenditures by Medicare should focus on drug prices. PMID:27009256

  14. Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market

    PubMed Central

    Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

    2013-01-01

    Objective To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Principal Findings Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Conclusions Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. PMID:23557215

  15. 14 CFR 1260.69 - Electronic funds transfer payment methods.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... designate a financial institution or to provide appropriate payee bank account information may delay... information: (1) Name, address, and telegraphic abbreviation of the financial institution receiving payment...) Payee's account number at the financial institution where funds are to be transferred. (4) If the...

  16. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study

    PubMed Central

    Loy, Bryan A.; Shkedy, Clive I.; Powell, Adam C.; Happe, Laura E.; Royalty, Julie A.; Miao, Michael T.; Smith, Gary L.; Long, James W.; Gupta, Amit K.

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations. PMID:26870963

  17. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

    PubMed

    Loy, Bryan A; Shkedy, Clive I; Powell, Adam C; Happe, Laura E; Royalty, Julie A; Miao, Michael T; Smith, Gary L; Long, James W; Gupta, Amit K

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

  18. The costs and financing of perinatal care in the United States.

    PubMed Central

    Long, S H; Marquis, M S; Harrison, E R

    1994-01-01

    OBJECTIVES. The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. METHODS. Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. RESULTS. The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. CONCLUSIONS. National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid. PMID:8092374

  19. Aligning provider incentives to improve primary healthcare delivery in the United States

    PubMed Central

    DeVoe, JE; Stenger, R

    2016-01-01

    Background The United States (US) is reforming primary care delivery systems, including the implementation of ‘patient-centered medical homes.’ Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms. Methods This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create ‘prisoner’s dilemmas’ that have stalled past reform efforts. It then uses this framework to illustrate, hypothetically, how advantages from different models could be blended together to encourage cooperation and improve the quality of primary care services delivered, thus providing an escape from current prisoner’s dilemmas faced by providers. Findings Improvements in primary care delivery will largely hinge on blended payment mechanisms that can effectively combine the advantageous elements of fee-for-service, capitation, and incentive payments into a balanced equation that enables providers to escape the perverse financial incentives of current payment mechanisms and overcome collective action problems. Conclusions If balanced appropriately, a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved. PMID:27942388

  20. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  1. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  2. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  3. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  4. 31 CFR 203.10 - Electronic payment methods.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Electronic payment methods. 203.10... TAX AND LOAN PROGRAM Electronic Federal Tax Payments § 203.10 Electronic payment methods. (a) General. Electronic payment methods for Federal tax payments available under this subpart include ACH debit entries...

  5. Bundled payment fails to gain a foothold In California: the experience of the IHA bundled payment demonstration.

    PubMed

    Ridgely, M Susan; de Vries, David; Bozic, Kevin J; Hussey, Peter S

    2014-08-01

    To determine whether bundled payment could be an effective payment model for California, the Integrated Healthcare Association convened a group of stakeholders (health plans, hospitals, ambulatory surgery centers, physician organizations, and vendors) to develop, through a consensus process, the methods and means of implementing bundled payment. In spite of a high level of enthusiasm and effort, the pilot did not succeed in its goal to implement bundled payment for orthopedic procedures across multiple payers and hospital-physician partners. An evaluation of the pilot documented a number of barriers, such as administrative burden, state regulatory uncertainty, and disagreements about bundle definition and assumption of risk. Ultimately, few contracts were signed, which resulted in insufficient volume to test hypotheses about the impact of bundled payment on quality and costs. Although bundled payment failed to gain a foothold in California, the evaluation provides lessons for future bundled payment initiatives. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

    PubMed Central

    2012-01-01

    Background In 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI. Methods A discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis. Results Reimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)). Conclusions Provider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid. PMID:22697498

  7. AMCP Guide to Pharmaceutical Payment Methods, 2009 Update (Version 2.0).

    PubMed

    2009-08-01

    The methods by which the U.S. health care system pays for prescription drugs have faced increasing scrutiny in recent years. Two key developments have emerged: (a) congressional enactment of important changes in the basis for payments for prescription drugs in the Medicare and Medicaid programs; and (b) a March 2009 decision in a federal class action lawsuit that alleged fraudulent manipulation of the dominant pricing benchmark (average wholesale price, AWP), used primarily as the basis for payment for brand-name prescription drugs. The debate about prescription drug payment methods centers on determining the most appropriate basis for calculating how payers, including patients, government agencies, employers, and health plans, should pay pharmacies and other providers for drugs. Historically, payment for prescription drugs has been based on published prices that do not necessarily reflect the actual acquisition costs paid by providers, primarily pharmacies, physicians, and hospitals. This has led policymakers to believe that Medicare and Medicaid programs have paid more than is necessary for prescription drugs. Thus, in an effort to reform the payment system and reduce drug expenditures, policymakers have made significant changes to the benchmarks used by public programs to pay for drugs, and in some instances have created new benchmarks. Private payers have followed the government's lead and begun to change their own payment methods and benchmarks. They can be expected to accelerate the change as a result of the settlement agreement approved in the March 2009 federal court decision. The settlement will result in the lowering of the AWP for more than 400 generic and brand-name drugs. In addition - and technically unrelated to the litigation and any appeals that may be taken - 2 major price data reporting companies, First DataBank and Medi-Span, announced their intent to discontinue publication of AWP within 2 years of September 26, 2009. (At the time this report was prepared, there have been no similar announcements from Thomson Healthcare for Redbook or from Elsevier for Gold Standard [ProspectoRx], who are 2 other publishers of prescription drug prices). Furthermore, several manufacturers have announced that they will no longer provide either an AWP or a markup percentage on certain pharmaceuticals.3 Thus, by 2011, the AWP benchmark as we know it will no longer be widely available for use by public or commercial payers for payment of pharmaceutical products.

  8. 48 CFR 52.232-36 - Payment by Third Party.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    .... Documentation of each charge against the Government's account shall be provided to the Contracting Officer upon... applicable, the particular Governmentwide commercial purchase card to be used are identified elsewhere in this contract. (2) The Governmentwide commercial purchase card is not authorized as a method of payment...

  9. Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jairam, Vikram; Yu, James B., E-mail: james.b.yu@yale.edu

    Purpose: To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. Methods and Materials: The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by providermore » and by transaction. Results: Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. Conclusions: Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician–industry relationships.« less

  10. Here comes the Sun Shine: Industry's Payments to Cardiothoracic Surgeons

    PubMed Central

    Hicks, Caitlin W.; Orandi, Babak J.; Atallah, Chady; Chow, Eric K.; Massie, Allan B.; Lopez, Joseph; Higgins, Robert S.; Segev, Dorry L.

    2016-01-01

    Background The Physician Payment Sunshine Act (PPSA) was implemented to provide transparency to financial transactions between industry and physicians. Under this law, the Open Payments Program (OPP) was created to publicly disclose all transactions and inform patients of potential conflicts-of-interest (COI). Collaboration between industry and cardiothoracic surgeon-scientists is essential in developing new approaches to treating patients with cardiac disease. The objective of this study is to characterize industry payments to cardiothoracic surgeons as reported by OPP. Methods We used the first wave of PPSA data (August 2013-December 2013) to assess industry payments made to cardiothoracic surgeons. Results Cardiothoracic surgeons (N=2,495) received a total of $4,417,545 during a five-month period. Cardiothoracic surgeons comprised of 0.5% of all individuals in the OPP and received 0.9% of total disclosed industry funding. Among cardiothoracic surgeons receiving funding, 34% received payments <$100, 43% received payments of $100-$999, 19% received payments of $1,000-$9,999, 4% received payments of $10,000-$99,999 and 0.2% received payments >$100,000. The median (IQR) was $181 (60-843) and the mean (±SD) was $1,771 (±7,664). The largest payment to an individual was $159,444. The three largest median (IQR) payments made to cardiothoracic surgeons by expense category were royalty fees $8,398 (536-12,316), speaker fees $3,600 (1,500-8,000), and Honoraria $3,344 (1,563-7,350). Conclusions Among cardiothoracic surgeons who are listed as recipients of non-research industry payments, 50% of cardiothoracic surgeons received <$181. Awareness of the OPP data is critical for cardiothoracic surgeons, as it provides a means to prevent potential public misconceptions about industry payments within the specialty that may affect patient trust. PMID:27353195

  11. Establishing and Balancing a Classroom Token Economy.

    ERIC Educational Resources Information Center

    Center, David B.; Arnault, Lynne

    The paper presents a classroom token economy system for providing classroom structure, eliminating or controlling a variety of problem behaviors, and for demonstration and teaching purposes. The first section addresses income production (payment for productive work using classroom work periods as payment periods). A percentage method in paying for…

  12. Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

    PubMed

    Phuong, Nguyen Khanh; Oanh, Tran Thi Mai; Phuong, Hoang Thi; Tien, Tran Van; Cashin, Cheryl

    2015-01-01

    Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

  13. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2011-10-01 2011-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

  14. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2014-10-01 2014-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

  15. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2013-10-01 2013-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

  16. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2010-10-01 2010-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

  17. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2012-10-01 2012-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

  18. Does capitation payment under national health insurance affect subscribers' trust in their primary care provider? a cross-sectional survey of insurance subscribers in Ghana.

    PubMed

    Andoh-Adjei, Francis-Xavier; Cornelissen, Dennis; Asante, Felix Ankomah; Spaan, Ernst; van der Velden, Koos

    2016-08-24

    Ghana introduced capitation payment for primary care in 2012 with the view to containing escalating claims expenditure. This shift in provider payment method raised issues about its potential impact on patient-provider trust relationship and insured-patients' trust in the Ghana National Health Insurance Scheme. This paper presents findings of a study that explored insured-patients' perception about, and attitude towards capitation payment in Ghana; and determined whether capitation payment affect insured-patients' trust in their preferred primary care provider and the National Health Insurance Scheme in general. We adopted a survey design for the study. We administered closed-ended questionnaires to collect data from insurance card-bearing members aged 18 years and above. We performed both descriptive statistics to determine proportions of observations relating to the variables of interest and chi-square test statistics to determine differences within gender and setting. Sixty-nine per cent (69 %) out of 344 of respondents selected hospital level of care as their primary care provider. The two most important motivations for the choice of a provider were proximity in terms of geographical access (40 %) and perceived quality of care (38 %). Eighty-eight per cent (88 %) rated their trust in their provider as (very) high. Eighty-two per cent (82 %) actively selected their providers. Eighty-eight per cent (88 %) had no intention to switch provider. A majority (91 %) would renew their membership when it expires. Female respondents (91 %; n = 281) were more likely to renew their membership than males (87 %; n = 63). Notwithstanding capitation payment experience, 81 % of respondents would recommend to their peers to enrol with the NHIS with rural dwellers (87 %; n = 156) being more likely to do so than urban dwellers (76 %; n = 188). Almost all respondents (92 %) rated the NHIS as (very) good. Health Insurance subscribers in Ghana have high trust in their primary care provider giving them quality care under capitation payment despite their negative attitude towards capitation payment. They are guided by proximity and quality of care considerations in their choice of provider. The NHIA would, however, have to address itself to the negative perceptions about the capitation payment policy.

  19. Exploring consumers’ attitudes towards informal patient payments using the combined method of cluster and multinomial regression analysis - the case of Hungary

    PubMed Central

    2013-01-01

    Background Previous studies on informal patient payments have mostly focused on the magnitude and determinants of these payments while the attitudes of health care actors towards these payments are less well known. This study aims to reveal the attitudes of Hungarian health care consumers towards informal payments to provide a better understanding of this phenomenon. Methods For the analysis, we use data from a survey carried out in 2010 in Hungary involving a representative sample of 1037 respondents. We use cluster analysis to identify the main attitude groups related to informal payments based on the respondents’ perception of and behavior related to informal payments. Multinomial logistic regression is applied to examine the differences between these groups in terms of socio-demographic characteristics, as well as past utilization and informal payments paid for health care services. Results We identified three main different attitudes towards informal payments: accepting informal payments, doubting about informal payments and opposing informal payments. Those who accept informal payments (mostly young or elderly people, living in the capital) consider these payments as an expression of gratitude and perceive them as inevitable due to the low funding of the health care system. Those who doubt about informal payments (mostly respondents outside the capital, with higher education and higher household income) are not certain whether these payments are inevitable, perceive them as similar to corruption rather than gratitude, and would rather use private services to avoid these payments. We find that the opposition to informal payments (mostly among men from small households and low income households) can be explained by their lower ability and willingness to pay. Conclusions A large share of Hungarian health care consumers has a rather positive attitude towards informal payments, perceiving them as “inevitable due to the low funding of the health care system”. From a policy point-of-view, the change of this consumer attitude will be essential to deal with these payments in addition to other policy strategies. PMID:23414488

  20. 14 CFR 1274.931 - Electronic funds transfer payment methods.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Electronic funds transfer payment methods... COOPERATIVE AGREEMENTS WITH COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.931 Electronic funds transfer payment methods. Electronic Funds Transfer Payment Methods July 2002 Payments under this...

  1. 14 CFR 1274.931 - Electronic funds transfer payment methods.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Electronic funds transfer payment methods... COOPERATIVE AGREEMENTS WITH COMMERCIAL FIRMS Other Provisions and Special Conditions § 1274.931 Electronic funds transfer payment methods. Electronic Funds Transfer Payment Methods July 2002 Payments under this...

  2. 14 CFR § 1260.69 - Electronic funds transfer payment methods.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Electronic funds transfer payment methods... GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.69 Electronic funds transfer payment methods. Electronic Funds Transfer Payment Methods October 2000 (a) Payments under this grant will be made...

  3. 14 CFR 1260.69 - Electronic funds transfer payment methods.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Electronic funds transfer payment methods... COOPERATIVE AGREEMENTS General Special Conditions § 1260.69 Electronic funds transfer payment methods. Electronic Funds Transfer Payment Methods October 2000 (a) Payments under this grant will be made by the...

  4. 14 CFR 1260.69 - Electronic funds transfer payment methods.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Electronic funds transfer payment methods... COOPERATIVE AGREEMENTS General Special Conditions § 1260.69 Electronic funds transfer payment methods. Electronic Funds Transfer Payment Methods October 2000 (a) Payments under this grant will be made by the...

  5. 14 CFR 1260.69 - Electronic funds transfer payment methods.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Electronic funds transfer payment methods... COOPERATIVE AGREEMENTS General Special Conditions § 1260.69 Electronic funds transfer payment methods. Electronic Funds Transfer Payment Methods October 2000 (a) Payments under this grant will be made by the...

  6. 37 CFR 1.23 - Methods of payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... made by credit card, except for replenishing a deposit account. Payment of a fee by credit card must specify the amount to be charged to the credit card and such other information as is necessary to process... authorization to charge fees to a credit card. If credit card information is provided on a form or document...

  7. 37 CFR 1.23 - Methods of payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... made by credit card, except for replenishing a deposit account. Payment of a fee by credit card must specify the amount to be charged to the credit card and such other information as is necessary to process... authorization to charge fees to a credit card. If credit card information is provided on a form or document...

  8. 37 CFR 1.23 - Methods of payment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... made by credit card, except for replenishing a deposit account. Payment of a fee by credit card must specify the amount to be charged to the credit card and such other information as is necessary to process... authorization to charge fees to a credit card. If credit card information is provided on a form or document...

  9. 37 CFR 1.23 - Methods of payment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... made by credit card, except for replenishing a deposit account. Payment of a fee by credit card must specify the amount to be charged to the credit card and such other information as is necessary to process... authorization to charge fees to a credit card. If credit card information is provided on a form or document...

  10. Emerging Lessons From Regional and State Innovation in Value-Based Payment Reform: Balancing Collaboration and Disruptive Innovation

    PubMed Central

    Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

    2014-01-01

    Policy Points: Public and private purchasersmust create a "burning bridge" of countervailing pressure that signals "no turning back" to fee-for-service in order to sustain the momentum for value-based payment. Multi-stakeholder coalitions must establish a defined set of quality, outcomes, and cost performance measures and the interoperable information systems to support data collection and reporting of value-based payment schemes. Anti-trust vigilance is necessary to find the "sweet spot" of competition and cooperation among health plans and health care providers. Provider and health plan transparency of price and quality, supported by all-payer claims data, are critical in driving value-based payment innovation and cost constraint. Context In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. Methods As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. Findings The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers’ limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a “burning bridge” between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of “reformed” fee-for-service with bundled payments and global payments. PMID:25199900

  11. 42 CFR 412.116 - Method of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Method of payment. 412.116 Section 412.116 Public... Payment Systems § 412.116 Method of payment. (a) General rules. (1) Unless the provisions of paragraphs (b... section is removed from that method of payment at its own request, it may reelect to receive periodic...

  12. Informal Payments for Health Care in Iran: Results of a Qualitative Study

    PubMed Central

    PARSA, Mojtaba; ARAMESH, Kiarash; NEDJAT, Saharnaz; KANDI, Mohammad Jafar; LARIJANI, Bagher

    2015-01-01

    Abstract Background Informal payments to health care providers have been reported in many African, Asian and European countries. This study aimed to investigate different aspects of these payments that are also known as under-the-table payments in Iran. Methods This is an in-depth interview-based qualitative study conducted on 12 purposively chosen clinical specialists. The interviewees answered 9 questions including the ones about, definitions of informal payments, the specialties and hospitals mostly involved with the problem, how they are paid, factors involved, motivation of patients for the payments, impact of the payments on the health care system and physician-patient relationship and the ways to face up with the problem. The findings of the study were analyzed using qualitative content analysis method. Results Six topics were extracted from the interviews including definitions, commonness, varieties, motivations, outcomes and preventive measures. It was revealed that under-the-table payments are the money taken (either in private or public portions) from patients in addition to what formally is determined. This problem is mostly seen in surgical services and the most important reason for it is unrealistic tariffs. Conclusion Regarding the soaring commonness of informal payments rooted in underpayments of health expenditures in some specialties, which deeply affect the poor, the government has to boost the capitation and to invest on health sectors through supporting the health insurance companies and actualizing the health care costs in accord with the real price of the health care delivered. PMID:26060779

  13. Customer-Specific Transaction Risk Management in E-Commerce

    NASA Astrophysics Data System (ADS)

    Ruch, Markus; Sackmann, Stefan

    Increasing potential for turnover in e-commerce is inextricably linked with an increase in risk. Online retailers (e-tailers), aiming for a company-wide value orientation should manage this risk. However, current approaches to risk management either use average retail prices elevated by an overall risk premium or restrict the payment methods offered to customers. Thus, they neglect customer-specific value and risk attributes and leave turnover potentials unconsidered. To close this gap, an innovative valuation model is proposed in this contribution that integrates customer-specific risk and potential turnover. The approach presented evaluates different payment methods using their risk-turnover characteristic, provides a risk-adjusted decision basis for selecting payment methods and allows e-tailers to derive automated risk management decisions per customer and transaction without reducing turnover potential.

  14. 5 CFR 1315.5 - Accelerated payment methods.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Accelerated payment methods. 1315.5 Section 1315.5 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.5 Accelerated payment methods. (a) A single invoice under $2,500. Payments may be made as soon as...

  15. 5 CFR 1315.5 - Accelerated payment methods.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Accelerated payment methods. 1315.5 Section 1315.5 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.5 Accelerated payment methods. (a) A single invoice under $2,500. Payments may be made as soon as...

  16. 5 CFR 1315.5 - Accelerated payment methods.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Accelerated payment methods. 1315.5 Section 1315.5 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.5 Accelerated payment methods. (a) A single invoice under $2,500. Payments may be made as soon as...

  17. Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

    PubMed

    Squitieri, Lee; Chung, Kevin C

    2017-07-01

    In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

  18. 37 CFR 2.207 - Methods of payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... credit card, except for replenishing a deposit account. Payment of a fee by credit card must specify the amount to be charged to the credit card and such other information as is necessary to process the charge... fees to a credit card. If credit card information is provided on a form or document other than a form...

  19. 37 CFR 2.207 - Methods of payment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... credit card, except for replenishing a deposit account. Payment of a fee by credit card must specify the amount to be charged to the credit card and such other information as is necessary to process the charge... fees to a credit card. If credit card information is provided on a form or document other than a form...

  20. 37 CFR 2.207 - Methods of payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... credit card, except for replenishing a deposit account. Payment of a fee by credit card must specify the amount to be charged to the credit card and such other information as is necessary to process the charge... fees to a credit card. If credit card information is provided on a form or document other than a form...

  1. 37 CFR 2.207 - Methods of payment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... credit card, except for replenishing a deposit account. Payment of a fee by credit card must specify the amount to be charged to the credit card and such other information as is necessary to process the charge... fees to a credit card. If credit card information is provided on a form or document other than a form...

  2. Knowledge, perceptions and expectations of capitation payment system in a health insurance setting: a repeated survey of clients and health providers in Kumasi, Ghana

    PubMed Central

    2013-01-01

    Background Health insurance is improving access to quality health care in Ghana. However, there are implementation challenges which call for reform of the current health insurance system. There is no doubt that reforming the current health insurance in Ghana is besieged with a myriad of problems due to misconceptions and misinformation. This study explored the perceptions and understanding of clients and health providers on the capitation payment system in the Kumasi metropolis. Methods The study employed a cross - sectional design and repeated surveys were conducted with a cohort of 422 NHIS policy holders aged 18–69 years in each survey. The surveys were conducted in every three months. Health service providers and clients from thirteen (13) Hospitals, seven (7) Maternity homes and twenty (20) Clinics were also interviewed. Data was collected with interviewer–administered questionnaires. STATA software (version 11) was used for cleaning, standardizing and analysing data. Results A majority, 97.9% of the clients interviewed had heard of capitation payment although this did not translate into their level of understanding. About two-thirds, 61.2% disclosed that capitation was not important to them as clients are restricted to one Preferred Primary Provider (PPP) for a long period of time. About 94% of health providers also believed that people did not like the capitation payment system due to their misconception that it has been politicized (34%); does not give clients free choice of providers (26%) and capitation not covering most drugs (17%). Conclusion Although awareness of the capitation was high among clients, attitudes towards the capitation payment system were somewhat poor. A good understanding of the capitation payment system is key to ensuring client and provider acceptance and smooth implementation of the system. PMID:24359034

  3. Comparison of alternative weight recalibration methods for diagnosis-related groups

    PubMed Central

    Rogowski, Jeannette Roskamp; Byrne, Daniel J.

    1990-01-01

    In this article, alternative methodologies for recalibration of the diagnosis-related group (DRG) weights are examined. Based on 1984 data, cost and charge-based weights are less congruent than those calculated with 1981 data. Previous studies using 1981 data demonstrated that cost- and charge-based weights were not very different. Charge weights result in higher payments to surgical DRGs and lower payments to medical DRGs, relative to cost weights. At the provider level, charge weights result in higher payments to large urban hospitals and teaching hospitals, relative to cost weights. PMID:10113568

  4. Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

    PubMed

    Squitieri, Lee; Chung, Kevin C

    2017-07-01

    In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

  5. Nursing home reimbursement and the allocation of rehabilitation therapy resources.

    PubMed

    Murtaugh, C M; Cooney, L M; DerSimonian, R R; Smits, H L; Fetter, R B

    1988-10-01

    Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to match rehabilitation therapy resources to a patient's needs. We were able to determine by a review of over 8,500 patients in 65 nursing homes that certain diagnoses, partial dependence in activities of daily living (ADLs), clear mental status, and improving medical status are associated with the provision of rehabilitation services to nursing home residents. These patient characteristics are clinically reasonable predictors of the need for therapy and should be considered for use in nursing home case-mix reimbursement systems. Primary payment source also was associated with the provision of rehabilitation services even after taking into account significant patient characteristics. It is unclear how much of the variation in service use across payers is due to differences in patient need as opposed to differences in the financial incentives associated with current payment methods.

  6. 42 CFR 413.64 - Payments to providers: Specific rules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... retroactive adjustment. (g) Accelerated payments to providers. Upon request, an accelerated payment may be... as a percentage of the net reimbursement for unbilled or unpaid covered services. Recovery of the accelerated payment may be made by recoupment as provider bills are processed or by direct payment. (h...

  7. 42 CFR 413.64 - Payments to providers: Specific rules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... retroactive adjustment. (g) Accelerated payments to providers. Upon request, an accelerated payment may be... as a percentage of the net reimbursement for unbilled or unpaid covered services. Recovery of the accelerated payment may be made by recoupment as provider bills are processed or by direct payment. (h...

  8. 42 CFR 413.64 - Payments to providers: Specific rules.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... retroactive adjustment. (g) Accelerated payments to providers. Upon request, an accelerated payment may be... as a percentage of the net reimbursement for unbilled or unpaid covered services. Recovery of the accelerated payment may be made by recoupment as provider bills are processed or by direct payment. (h...

  9. 30 CFR 1219.102 - Method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Method of payment. 1219.102 Section 1219.102... Resources Revenue DISTRIBUTION AND DISBURSEMENT OF ROYALTIES, RENTALS, AND BONUSES § 1219.102 Method of... Transfer (EFT). Should a State prefer to receive its payment by EFT, it should request this payment method...

  10. 42 CFR 414.314 - Monthly capitation payment method.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Monthly capitation payment method. 414.314 Section... Determination of Reasonable Charges Under the ESRD Program § 414.314 Monthly capitation payment method. (a) Basic rules. (1) Under the monthly capitation payment (MCP) method, the carrier pays an MCP amount for...

  11. 26 CFR 15a.453-1 - Installment method reporting for sales of real property and casual sales of personal property.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... general. The term “installment sale” means a disposition of property (except as provided in paragraph (b... in which the disposition occurs. The term “installment sale” includes dispositions from which payment... reporting of contingent payment sales. (ii) Selling price defined. The term “selling price” means the gross...

  12. 26 CFR 15a.453-1 - Installment method reporting for sales of real property and casual sales of personal property.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... general. The term “installment sale” means a disposition of property (except as provided in paragraph (b... in which the disposition occurs. The term “installment sale” includes dispositions from which payment... reporting of contingent payment sales. (ii) Selling price defined. The term “selling price” means the gross...

  13. 40 CFR 1027.130 - How do I make a fee payment?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... method available for payment online at www.Pay.gov., or as specified in EPA guidance. (b) Send a... www.Pay.gov., or as provided in EPA guidance. These forms are available on the Internet at http://www.epa.gov/otaq/guidance.htm. (c) You must pay the fee amount due before we will start to process an...

  14. 40 CFR 1027.130 - How do I make a fee payment?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... method available for payment online at www.Pay.gov., or as specified in EPA guidance. (b) Send a... www.Pay.gov., or as provided in EPA guidance. These forms are available on the Internet at http://www.epa.gov/otaq/guidance.htm. (c) You must pay the fee amount due before we will start to process an...

  15. Geographic variations in hospital charges and Medicare payments for major joint arthroplasty.

    PubMed

    Thakore, Rachel V; Greenberg, Sarah E; Bulka, Catherine M; Ehrenfeld, Jesse M; Obremskey, William T; Sethi, Manish K

    2015-05-01

    National data on hospital-level charges and Medicare payments have shown that joint arthroplasty is the most common surgical procedure among the elderly. Yet, no study has investigated micro and macro level geographic variations in hospital charges and payment. We used the Medicare Provider Charge Data to investigate Medicare payments and charges for 2750 hospitals accounting for 427,207 patients who underwent major joint arthroplasty and 932 hospitals for 18,714 patients who had a complication/comorbidity. We found a significant difference in hospital charges and payments based on geographic region (P<0.001). We concluded that hospital charges demonstrate a high variability even when using areas to control for differences in hospital wages and high variation in reimbursements in some areas remains unexplained by Medicare's current method of calculating reimbursement. Published by Elsevier Inc.

  16. The Theory of Value-Based Payment Incentives and Their Application to Health Care.

    PubMed

    Conrad, Douglas A

    2015-12-01

    To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

  17. Medicare's post-acute care payment: a review of the issues and policy proposals.

    PubMed

    Linehan, Kathryn

    2012-12-07

    Medicare spending on post-acute care provided by skilled nursing facility providers, home health providers, inpatient rehabilitation facility providers, and long-term care hospitals has grown rapidly in the past several years. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems and also includes broader payment reforms, such as bundled payment models. This issue brief describes Medicare's payment systems for post-acute care providers, evidence of problems that have been identified with the payment systems, and policies that have been proposed or enacted to remedy those problems.

  18. Bundling Post-Acute Care Services into MS-DRG Payments

    PubMed Central

    Vertrees, James C.; Averill, Richard F.; Eisenhandler, Jon; Quain, Anthony; Switalski, James

    2013-01-01

    Objective A bundled hospital payment system that encompasses both acute and post-acute care has been proposed as a means of creating financial incentives in the Medicare fee-for-service system to foster care coordination and to improve the current disorganized system of post care. The objective of this study was to evaluate the statistical stability of alternative designs of a hospital payment system that includes post-acute care services to determine the feasibility of using a combined hospital and post-acute care bundle as a unit of payment. Methods The Medicare Severity-Diagnosis Related Groups (MS-DRGs) were subdivided into clinical subclasses that measured a patient's chronic illness burden to test whether a patient's chronic illness burden had a substantial impact on post-acute care expenditures. Using Medicare data the statistical performance of the MS-DRGs with and without the chronic illness subclasses was evaluated across a wide range of post-acute care windows and combinations of post-acute care service bundles using both submitted charges and Medicare payments. Results The statistical performance of the MS-DRGs as measured by R2 was consistently better when the chronic illness subclasses are included indicating that MS-DRGs by themselves are an inadequate unit of payment for post-acute care payment bundles. In general, R2 values increased as the post-acute care window length increased and decreased as more services were added to the post-acute care bundle. Discussion The study results suggest that it is feasible to develop a payment system that incorporates significant post-acute care services into the MS-DRG inpatient payment bundle. This expansion of the basic DRG payment approach can provide a strong financial incentive for providers to better coordinate care potentially leading to improved efficiency and outcome quality. PMID:24753970

  19. A contingent payment model of smoking cessation: effects on abstinence and withdrawal.

    PubMed

    Heil, Sarah H; Tidey, Jennifer W; Holmes, Heather W; Badger, Gary J; Higgins, Stephen T

    2003-04-01

    The present study was designed to characterize nicotine withdrawal during a 5-day period in which smokers who were not trying to quit were offered monetary incentives to abstain while residing in their usual environments. Participants were randomly assigned to one of three groups. In two groups, monetary payment was delivered contingent on breath carbon monoxide levels (CO< or =8 ppm) indicating recent smoking abstinence, with the amount of payment differing between the two groups. The third group was a control group in which payment was delivered independent of smoking status. Participants provided CO samples three times per day (morning, afternoon- and evening) for 5 days (Monday-Friday). At each evening visit, all participants completed a nicotine withdrawal questionnaire and other questionnaires. Contingent payment significantly decreased expired-air CO and salivary cotinine levels as compared with the control group. No significant differences in abstinence were noted as a function of the amount paid. Participants in both contingent payment groups reported significantly more withdrawal symptoms than those in the noncontingent control group, including increases in anxiety and nervousness, impatience and restlessness, hunger, and desire to smoke. Such contingent payment procedures may provide an effective method for studying nicotine withdrawal in smokers that does not require the costly and inconvenient practice of housing research participants on a closed ward to prevent smoking.

  20. 42 CFR 414.314 - Monthly capitation payment method.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Monthly capitation payment method. 414.314 Section... Reasonable Charges Under the ESRD Program § 414.314 Monthly capitation payment method. (a) Basic rules. (1) Under the monthly capitation payment (MCP) method, the carrier pays an MCP amount for each patient, to...

  1. 76 FR 62327 - Retail Inventory Method

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-07

    ... Retail Inventory Method AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed rulemaking. SUMMARY: This document contains proposed regulations relating to the retail inventory method of... inventory method and provide a special rule for certain taxpayers that receive margin protection payments...

  2. 30 CFR 1218.155 - Method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Method of payment. 1218.155 Section 1218.155... Sulfur, Offshore § 1218.155 Method of payment. (a) Payment of royalties and rentals. With the exception... with the bid will be included in the notice of each lease offering. EFT may be used as a method of...

  3. QuickCash: Secure Transfer Payment Systems

    PubMed Central

    Alhothaily, Abdulrahman; Alrawais, Arwa; Song, Tianyi; Lin, Bin; Cheng, Xiuzhen

    2017-01-01

    Payment systems play a significant role in our daily lives. They are an important driver of economic activities and a vital part of the banking infrastructure of any country. Several current payment systems focus on security and reliability but pay less attention to users’ needs and behaviors. For example, people may share their bankcards with friends or relatives to withdraw money for various reasons. This behavior can lead to a variety of privacy and security issues since the cardholder has to share a bankcard and other sensitive information such as a personal identification number (PIN). In addition, it is commonplace that cardholders may lose their cards, and may not be able to access their accounts due to various reasons. Furthermore, transferring money to an individual who has lost their bankcard and identification information is not a straightforward task. A user-friendly person-to-person payment system is urgently needed to perform secure and reliable transactions that benefit from current technological advancements. In this paper, we propose two secure fund transfer methods termed QuickCash Online and QuickCash Offline to transfer money from peer to peer using the existing banking infrastructure. Our methods provide a convenient way to transfer money quickly, and they do not require using bank cards or any identification card. Unlike other person-to-person payment systems, the proposed methods do not require the receiving entity to have a bank account, or to perform any registration procedure. We implement our QuickCash payment systems and analyze their security strengths and properties. PMID:28608846

  4. QuickCash: Secure Transfer Payment Systems.

    PubMed

    Alhothaily, Abdulrahman; Alrawais, Arwa; Song, Tianyi; Lin, Bin; Cheng, Xiuzhen

    2017-06-13

    Payment systems play a significant role in our daily lives. They are an important driver of economic activities and a vital part of the banking infrastructure of any country. Several current payment systems focus on security and reliability but pay less attention to users' needs and behaviors. For example, people may share their bankcards with friends or relatives to withdraw money for various reasons. This behavior can lead to a variety of privacy and security issues since the cardholder has to share a bankcard and other sensitive information such as a personal identification number (PIN). In addition, it is commonplace that cardholders may lose their cards, and may not be able to access their accounts due to various reasons. Furthermore, transferring money to an individual who has lost their bankcard and identification information is not a straightforward task. A user-friendly person-to-person payment system is urgently needed to perform secure and reliable transactions that benefit from current technological advancements. In this paper, we propose two secure fund transfer methods termed QuickCash Online and QuickCash Offline to transfer money from peer to peer using the existing banking infrastructure. Our methods provide a convenient way to transfer money quickly, and they do not require using bank cards or any identification card. Unlike other person-to-person payment systems, the proposed methods do not require the receiving entity to have a bank account, or to perform any registration procedure. We implement our QuickCash payment systems and analyze their security strengths and properties.

  5. Capitated payments to primary care providers and the delivery of patient education.

    PubMed

    Pearson, William S; King, Dana E; Richards, Chesley

    2013-01-01

    Patient education is a critical component of the patient-centered medical home and is a powerful and effective tool in chronic disease management. However, little is known about the effect of practice payment on rates of patient education during office encounters. For this study we took data from the 2009 National Ambulatory Medical Care Survey. This was a cross-sectional analysis of patient visits to primary care providers to determine whether practice payment in the form of capitated payments is associated within patient education being included more frequently during office visits compared with other payment methods. In a sample size of 9863 visits in which capitation status was available and the provider was the patient's primary care provider, the weighted percentages of visits including patient education were measured as a percentages of education (95% confidence intervals): <25% capitation, 42.7% (38.3-47.3); 26% to 50% capitation, 37.6% (23.5-54.2); 51% to 75% capitation, 38.4% (28.1-49.8); >75% capitation, 74.0% (52.2-88.1). In an adjusted logistic model controlling for new patients (yes/no), number of chronic conditions, number of medications managed, number of previous visits within the year, and age and sex of the patients, the odds of receiving education were reported as odds ratios (95% confidence intervals): <25% capitation, 1.00 (1.00-1.00); 26% to 50% capitation, 0.77 (0.38-1.58); 51% to 75% capitation, 0.81 (0.53-1.25); and >75% capitation, 3.38 (1.23-9.30). Patients are more likely to receive education if their primary care providers receive primarily capitated payment. This association is generally important for health policymakers constructing payment strategies for patient populations who would most benefit from interventions that incorporate or depend on patient education, such as populations requiring management of chronic diseases.

  6. 37 CFR 1.23 - Methods of payment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Methods of payment. 1.23 Section 1.23 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF... Methods of payment. (a) All payments of money required for United States Patent and Trademark Office fees...

  7. 18 CFR 381.105 - Method of payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Method of payment. 381.105 Section 381.105 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REVISED GENERAL RULES FEES General Provisions § 381.105 Method of payment. Fee payment...

  8. 30 CFR 1218.301 - Method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Method of payment. 1218.301 Section 1218.301 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR Natural... Resources § 1218.301 Method of payment. The payor shall tender all payments in accordance with § 1218.51...

  9. 18 CFR 381.105 - Method of payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Method of payment. 381.105 Section 381.105 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REVISED GENERAL RULES FEES General Provisions § 381.105 Method of payment. Fee payment...

  10. Comparing the performance of English mental health providers in achieving patient outcomes.

    PubMed

    Moran, Valerie; Jacobs, Rowena

    2015-09-01

    Evidence on provider payment systems that incorporate patient outcomes is limited for mental health care. In England, funding for mental health care services is changing to a prospective payment system with a future objective of linking some part of provider payment to outcomes. This research examines performance of mental health providers offering hospital and community services, in order to investigate if some are delivering better outcomes. Outcomes are measured using the Health of the Nation Outcome Scales (HoNOS) - a clinician-rated routine outcome measure (CROM) mandated for national use. We use data from the Mental Health Minimum Data Set (MHMDS) - a dataset on specialist mental health care with national coverage - for the years 2011/12 and 2012/13 with a final estimation sample of 305,960 observations with follow-up HoNOS scores. A hierarchical ordered probit model is used and outcomes are risk adjusted with independent variables reflecting demographic, need, severity and social indicators. A hierarchical linear model is also estimated with the follow-up total HoNOS score as the dependent variable and the baseline total HoNOS score included as a risk-adjuster. Provider performance is captured by a random effect that is quantified using Empirical Bayes methods. We find that worse outcomes are associated with severity and better outcomes with older age and social support. After adjusting outcomes for various risk factors, variations in performance are still evident across providers. This suggests that if the intention to link some element of provider payment to outcomes becomes a reality, some providers may gain financially whilst others may lose. The paper contributes to the limited literature on risk adjustment of outcomes and performance assessment of providers in mental health in the context of prospective activity-based payment systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Medicare payments to the neurology workforce in 2012.

    PubMed

    Skolarus, Lesli E; Burke, James F; Callaghan, Brian C; Becker, Amanda; Kerber, Kevin A

    2015-04-28

    Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%-51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. © 2015 American Academy of Neurology.

  12. Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines.

    PubMed

    Tobe, Makoto; Stickley, Andrew; del Rosario, Rodolfo B; Shibuya, Kenji

    2013-08-01

    OBJECTIVE The National Health Insurance Program (NHIP) in the Philippines is a social health insurance system partially subsidized by tax-based financing which offers benefits on a fee-for-service basis up to a fixed ceiling. This paper quantifies the extent to which beneficiaries of the NHIP incur out-of-pocket expenses for inpatient care, and examines the characteristics of beneficiaries making these payments and the hospitals in which these payments are typically made. METHODS Probit and ordinary least squares regression analyses were carried out on 94 531 insurance claims from Benguet province and Baguio city during the period 2007 to 2009. RESULTS Eighty-six per cent of claims involved an out-of-pocket payment. The median figure for out-of-pocket payments was Philippine Pesos (PHP) 3016 (US$67), with this figure varying widely [inter-quartile range (IQR): PHP 9393 (US$209)]. Thirteen per cent of claims involved very large out-of-pocket payments exceeding PHP 19 213 (US$428)-the equivalent of 10% of the average annual household income in the region. Membership type, disease severity, age and residential location of the patient, length of hospitalization, and ownership and level of the hospital were all significantly associated with making out-of-pocket payments and/or the size of these payments. CONCLUSION Although the current NHIP reduces the size of out-of-pocket payments, NHIP beneficiaries are not completely free from the risk of large out-of-pocket payments (as the size of these payments varies widely and can be extremely large), despite NHIP's attempts to mitigate this by setting different benefit ceilings based on the level of the hospital and the severity of the disease. To reduce these large out-of-pocket payments and to increase financial risk protection further, it is essential to ensure more investment for health from social health insurance and/or tax-based government funding as well as shifting the provider payment mechanism from a fee-for-service to a case-based payment method (which up until now has only been partially implemented).

  13. 30 CFR 1218.201 - Method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Method of payment. 1218.201 Section 1218.201 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR Natural...-General § 1218.201 Method of payment. You must tender all payments in accordance with § 1218.51, except as...

  14. Willingness to Pay for Hospice Care Using the Contingent Valuation Method

    PubMed Central

    Kim, Mee-Ok; Kim, Jung-Hoe; Joo, Ji-Soo

    2011-01-01

    Purpose It is necessary to develop a proper payment system for more health care facilities to provide hospice and palliative cares. In deciding the proper level of payment for hospice per diem fee, willingness to pay (WTP) may provide one of the critical information. This study was conducted to determine WTP for hospice care and to analyze those factors affecting WTP. Materials and Methods A contingent valuation method with a double-bounded dichotomous-choice model was used. Interview survey was organized and conducted by a survey company from April 4 to 18, 2008. The mean WTP was calculated through an infinite integration of survival functions. Results The average willingness to pay was found to be 42,240 Korean won (KRW) (USD 35), with the amount becoming higher as hospice services were deemed more necessary or where average monthly household income was higher. The amount was also higher among male respondents than females. Conclusion To compare this WTP with actual cost (32,500 KRW) (USD 27) for hospice care. To facilitate hospice service, hospice specific payment system should be developed. This study provides information regarding the general public's preference of hospice service and their WTP for hospice care, and it may be useful in the decision-making process. PMID:21488196

  15. 48 CFR 227.7009-4 - Additional clauses-contracts providing for payment of a running royalty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...-contracts providing for payment of a running royalty. 227.7009-4 Section 227.7009-4 Federal Acquisition... clauses—contracts providing for payment of a running royalty. The clauses set forth below are examples... desired to cover the subject matter thereof and the contract provides for payment of a running royalty. (a...

  16. 48 CFR 227.7009-4 - Additional clauses-contracts providing for payment of a running royalty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-contracts providing for payment of a running royalty. 227.7009-4 Section 227.7009-4 Federal Acquisition... clauses—contracts providing for payment of a running royalty. The clauses set forth below are examples... desired to cover the subject matter thereof and the contract provides for payment of a running royalty. (a...

  17. Comparative analysis of the current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology.

    PubMed

    Babić, Uroš; Soldatović, Ivan; Vuković, Dejana; Milićević, Milena Šantrić; Stjepanović, Mihailo; Kojić, Dejan; Argirović, Aleksandar; Vukotić, Vinka

    2015-03-01

    Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0.001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001) as well as under the projected DRG payment system (β = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the pro- jected DRG payment methods (β = 0.501, p < 0.001). Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.

  18. Using the stated preference technique for eliciting valuations: the role of the payment vehicle.

    PubMed

    Gyrd-Hansen, Dorte

    2013-10-01

    At the core of the stated preference method is choice of payment vehicle. Since payment vehicle is an intrinsic characteristic of a good, the choice of payment vehicle will naturally impact on the valuation of the good. Typical payment vehicles applied in the context of health are income tax levies, out-of-pocket payments at the point of consumption or private health insurance premiums. Where out-of-pocket payments will elicit use value only, private health insurance premiums will also disclose option value, i.e. the utility of knowing that one has access to a healthcare service should one need it. Income tax levies will disclose what in this paper is referred to as citizen's preferences, i.e. individual preferences that include use value, option value as well as (caring) externalities. This paper advocates that researchers design stated preference studies that encompass all relevant dimensions of value, and that serious thought is given to choice of payment vehicle. However, it is important to acknowledge that choice of payment vehicle has other potential implications for valuations. Payment vehicle and provider of services may be strongly linked in people's minds. If respondents implicitly associate a specific type of provider with a certain type of payment vehicle, it is important that any misperception is corrected by way of a precise description of the good being valued. Further, a pertinent issue is the extent to which respondents 'protest' to the stated preference question and how we should deal with these 'protesters'. No agreement currently exists about the procedure used to separate genuine zero values from protest values, nor about the treatment of protest responses in subsequent analyses. Beliefs are strongly associated with protesting, and exclusion of protest bids may therefore exclude individuals who have strong preferences for a payment vehicle. If it is acknowledged that payment vehicle is an intrinsic component of a good, exclusion of respondents who exhibit specific viewpoints may result in biased welfare estimates. Yet another issue is the presence of self-consciousness amongst respondents. If people derive utility from saying they are willing to pay for a public good (social desirability bias or warm glow), this potentially drives a wedge between people's stated value for a good in a survey and people's value for a good provided to them from the government. Tax payments are more binding than out-of-pocket payments. Payment towards public health programs via income tax may therefore generate lower consumer surplus than if the intervention was financed out-of-pocket with the option of opting out both in terms of participation as well as financially. Finally, only a few studies have looked at the impact of frequency of payments. The effect of temporal framing is clearly potentially important and at the same time an unavoidable component of the payment vehicle, yet it remains at present unexplored.

  19. Good, better, best? A comprehensive comparison of healthcare providers' performance: An application to physiotherapy practices in primary care.

    PubMed

    Steenhuis, Sander; Groeneweg, Niels; Koolman, Xander; Portrait, France

    2017-12-01

    Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care. We merged these datasets at the patient-level and compared the performances of these practices using case-mix corrected linear regression models. Several significant differences in performance were detected between practices. These results can be used by both physiotherapists, to improve treatment given, and insurers to support their purchasing decisions. The study demonstrates that it is feasible to compare the performance of providers using PROMs and PREMs. However, it would take an extra effort to increase usefulness and it remains unclear under which conditions this effort is cost-effective. Healthcare providers need to be aware of the added value of registering outcomes to improve their quality. Insurers need to facilitate this by designing value-based contracts with the right incentives. Only then can payment methods contribute to value-based healthcare and increase value for patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Merit-Based Incentive Payment System (MIPS): Harsh Choices For Interventional Pain Management Physicians.

    PubMed

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

    2016-01-01

    The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score. Additionally, Clinical Practice Improvement Activities (CPIA), contributing 15% of the composite score, create multiple strategic goals to design incentives that drive movement toward delivery system reform principles with inclusion of Advanced Alternative Payment Models (APMs). Under the present proposal, the Centers for Medicare and Medicaid Services (CMS) has estimated approximately 30,000 to 90,000 providers from a total of over 761,000 providers will be exempt from MIPS. About 87% of solo practitioners and 70% of practitioners in groups of less than 10 will be subjected to negative payments or penalties ranging from 4% to 9%. In addition, MIPS also will affect a provider's reputation by making performance measures accessible to consumers and third-party physician rating Web sites.The MIPS composite performance scoring method, at least in theory, utilizes weights for each performance category, exceptional performance factors to earn bonuses, and incorporates the special circumstances of small practices.In conclusion, MIPS has the potential to affect practitioners negatively. Interventional Pain Medicine practitioners must understand the various MIPS measures and how they might participate in order to secure a brighter future. Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, clinical practice improvement activities, advancing care information performance category.

  1. Early adoption of cyclosporine and recombinant human erythropoietin: clinical, economic, and policy issues with emergence of high-cost drugs.

    PubMed

    Powe, N R; Eggers, P W; Johnson, C B

    1994-07-01

    The discovery of new drugs and their introduction into US markets will become an intense area of focus should health care reform result in Medicare insurance coverage for prescription drugs. Particular attention will be focused on high-cost drugs. Two high-cost drugs, cyclosporine and recombinant human erythropoietin (rHuEPO), introduced into the clinical management of patients with kidney disease during the past decade, provide some experience concerning the forces affecting the use of expensive drugs in a cost-conscious health care system. The decision to prescribe a drug will depend on provider's judgements of the drug's clinical benefits and costs compared with those of other possible therapies. It may also depend on payment policy. Both cyclosporine and rHuEPO were adopted rapidly and extensively by providers of end-stage renal disease care following US Food and Drug Administration approval, despite their high costs. Both drugs were remarkably effective, relatively safe, and able to be administered without great difficulty compared with the therapies they have replaced. There was no additional payment to hospitals for the initial use of cyclosporine, which was introduced in 1983 at the time when Medicare's prospective payment was established, since choice of immunosuppressive agent did not affect the fixed, per-admission payment determined by the diagnosis-related group for kidney transplantation. Medicare coverage for continuing outpatient use of cyclosporine was not initially provided, in contrast to rHuEPO, which was introduced in 1989 with Medicare outpatient coverage and payment of 80% of the allowed charge. Despite their high costs and different methods of insurance payment both drugs achieved a rather quick and high penetration rate into their respective populations.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Medicaid provider reimbursement policy for adult immunizations☆

    PubMed Central

    Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.

    2015-01-01

    Background State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Objective Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Design Observational analysis using document review and a survey. Setting and participants Medicaid administrators in 50 states and the District of Columbia. Measurements Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Results Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Limitations Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Conclusions Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. PMID:26403369

  3. Medicaid provider reimbursement policy for adult immunizations.

    PubMed

    Stewart, Alexandra M; Lindley, Megan C; Cox, Marisa A

    2015-10-26

    State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Observational analysis using document review and a survey. Medicaid administrators in 50 states and the District of Columbia. Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. The Relationship of Industry Payments to Prescribing Behavior: A Study of Degarelix and Denosumab

    PubMed Central

    Bandari, Jathin; Turner, Robert M.; Jacobs, Bruce L.; Canes, David; Moinzadeh, Ali; Davies, Benjamin J.

    2017-01-01

    Introduction The influence of financial ties to pharmaceutical companies remains controversial. We aimed to assess a potential relationship between pharmaceutical payments and prescription patterns for degarelix and denosumab. Materials and Methods Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Medicare B) data containing 2012 claims compared to OpenPayments (Sunshine Act) data for the second half of 2013. Urologists and medical oncologists who billed Medicare for degarelix or denosumab were cross referenced in both databases and payments were aggregated into a consolidated dataset. Adjusted beneficiary count and total Medicare reimbursement were compared according to receipt of Sunshine payment, and an association between Sunshine payment amount and total Medicare reimbursement was also assessed. Results Of the 160 prescribers of degarelix and 1,507 prescribers of denosumab, 91 (57%) and 854 (57%) received Sunshine payment, respectively. Degarelix prescribers who received Sunshine payment had higher median total Medicare reimbursement ($13,257 vs. $9,554, p = 0.01). Denosumab prescribers who received Sunshine payment had both higher median adjusted beneficiary count (55 vs. 50, p < 0.001) and median total Medicare reimbursement ($69,620 vs. $60,732, p < 0.001). On multivariable analysis, both receipt of Sunshine payment (adjusted median difference $5,844, 95% CI $937 - $10,749) and oncology specialty (adjusted median difference $34,380, 95% CI $26,715 - $42,045) were independently associated with total Medicare reimbursement for denosumab. Conclusions In the case of degarelix and denosumab, there is a weak association between pharmaceutical company payments on prescribers' prescription behavior patterns. PMID:28149927

  5. 42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS... PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals... payment system. The prospective payment system includes payment for inpatient operating costs of...

  6. 29 CFR 3.10 - Methods of payment of wages.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Methods of payment of wages. 3.10 Section 3.10 Labor Office... IN WHOLE OR IN PART BY LOANS OR GRANTS FROM THE UNITED STATES § 3.10 Methods of payment of wages. The payment of wages shall be by cash, negotiable instruments payable on demand, or the additional forms of...

  7. RUGs and "Medi-Cal" systems for classifying nursing home patients.

    PubMed

    Grimaldi, P L

    1985-12-01

    Medicare and most state Medicaid programs currently use indirect case-mix measures to determine reimbursement for nursing home care. In the future, however, they probably will incorporate more direct case-mix measures into their payment systems. Care must be exercised in designing a case-based prospective payment system to ensure that its financial incentives motivate providers to expedite recovery, prevent deterioration, and admit heavy-care patients. For example, although use of a services-rendered approach helps guarantee that care will be provided when needed, it also offers providers an incentive to furnish a service regardless of whether it is in the patient's best interest. Consideration must be given to the frequency with which patients are reassessed. The implications of the timing of reassessments for quality of care also must be studied. Ideally, quality would be measured on an outcome basis--that is, payment would depend on whether targeted goals for individual patients are reached--rather than on structural or process measures alone. Two recent classification systems--Resource Utilization Groups and Medi-Cal groups--may serve as models for case-based prospective payment systems. Each method classifies patients into distinct, meaningful categories based on activities of daily living and services received.

  8. Design and impact of bundled payment for detox and follow-up care.

    PubMed

    Quinn, Amity E; Hodgkin, Dominic; Perloff, Jennifer N; Stewart, Maureen T; Brolin, Mary; Lane, Nancy; Horgan, Constance M

    2017-11-01

    Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients' utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States. Bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs. However, if moving to bundled payment creates large losses for some providers, it may not be sustainable. The objective of this study was to design the first bundled payment for detox and follow-up care and to estimate its impact on provider revenues. Massachusetts Medicaid beneficiaries' behavioral health, medical, and pharmacy claims from July 2010-April 2013 were used to build and test a detox bundled payment for continuously enrolled adults (N=5521). A risk adjustment model was developed using general linear modeling to predict beneficiaries' episode costs. The projected payments to each provider from the risk adjustment analysis were compared to the observed baseline costs to determine the potential impact of a detox bundled payment reform on organizational revenues. This was modeled in two ways: first assuming no change in behavior and then assuming a supply-side cost sharing behavioral response of a 10% reduction in detox readmissions and an increase of one individual counseling and one group counseling session. The mean total 90-day detox episode cost was $3743. Nearly 70% of the total mean cost consists of the index detox, psychiatric inpatient care, and short-term residential care. Risk mitigation, including risk adjustment, substantially reduced the variation of the mean episode cost. There are opportunities for organizations to gain revenue under this bundled payment design, but many providers will lose money under a bundled payment designed using historic payment and costs. Designing a bundled payment for detox and follow-up care is feasible, but low case volume and the adequacy of the payment are concerns. Thus, a detox episode-based payment will likely be more challenging for smaller, independent SUD treatment providers. These providers are experiencing many changes as financing shifts away from block grant funding toward Medicaid funding. A detox bundled payment in practice would need to consider different risk mitigation strategies, provider pooling, and costs based on episodes of care meeting quality standards, but could incentivize care coordination, which is important to reducing detox readmissions and engaging patients in care. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as inpatient rehabilitation...) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient.... (2) Approval of payment. An inpatient rehabilitation facility's request for an accelerated payment...

  10. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as inpatient rehabilitation...) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient.... (2) Approval of payment. An inpatient rehabilitation facility's request for an accelerated payment...

  11. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as inpatient rehabilitation...) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient.... (2) Approval of payment. An inpatient rehabilitation facility's request for an accelerated payment...

  12. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as inpatient rehabilitation...) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient.... (2) Approval of payment. An inpatient rehabilitation facility's request for an accelerated payment...

  13. Effect of Medicaid Payment on Rehabilitation Care for Nursing Home Residents

    PubMed Central

    Wodchis, Walter P.; Hirth, Richard A.; Fries, Brant E.

    2007-01-01

    There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents. PMID:17645160

  14. Effect of Medicaid payment on rehabilitation care for nursing home residents.

    PubMed

    Wodchis, Walter P; Hirth, Richard A; Fries, Brant E

    2007-01-01

    There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents.

  15. The Alignment and Blending of Payment Incentives within Physician Organizations

    PubMed Central

    Robinson, James C; Shortell, Stephen M; Li, Rui; Casalino, Lawrence P; Rundall, Thomas

    2004-01-01

    Objective To analyze the blend of retrospective (fee-for-service, productivity-based salary) and prospective (capitation, nonproductivity-based salary) methods for compensating individual physicians within medical groups and independent practice associations (IPAs) and the influence of managed care on the compensation blend used by these physician organizations. Data Sources Of the 1,587 medical groups and IPAs with 20 or more physicians in the United States, 1,104 responded to a one-hour telephone survey, with 627 providing detailed information on physician payment methods. Study Design We calculated the distribution of compensation methods for primary care and specialty physicians, separately, in both medical groups and IPAs. Multivariate regression methods were used to analyze the influence of market and organizational factors on the payment method developed by physician organizations for individual physicians. Principal Findings Within physician organizations, approximately one-quarter of physicians are paid on a purely retrospective (fee-for-service) basis, approximately one-quarter are paid on a purely prospective (capitation, nonproductivity-based salary) basis, and approximately one-half on blends of retrospective and prospective methods. Medical groups and IPAs in heavily penetrated managed care markets are significantly less likely to pay their individual physicians based on fee-for-service than are organizations in less heavily penetrated markets. Conclusions Physician organizations rely on a wide range of prospective, retrospective, and blended payment methods and seek to align the incentives faced by individual physicians with the market incentives faced by the physician organization. PMID:15333124

  16. 20 CFR 404.2108 - Requirements for payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

  17. 20 CFR 416.2208 - Requirements for payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

  18. 20 CFR 416.2208 - Requirements for payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

  19. 20 CFR 404.2108 - Requirements for payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

  20. 20 CFR 416.2208 - Requirements for payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

  1. 20 CFR 416.2208 - Requirements for payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

  2. 20 CFR 404.2108 - Requirements for payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

  3. 20 CFR 404.2108 - Requirements for payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

  4. 20 CFR 404.2108 - Requirements for payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

  5. 20 CFR 416.2208 - Requirements for payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

  6. Informal Patient Payments and Bought and Brought Goods in the Western Balkans – A Scoping Review

    PubMed Central

    Buch Mejsner, Sofie; Eklund Karlsson, Leena

    2017-01-01

    Introduction: Informal patient payments for healthcare are common in the Western Balkans, negatively affecting public health and healthcare. Aim: To identify literature from the Western Balkans on what is known about informal patient payments and bought and brought goods, to examine their effects on healthcare and to determine what actions can be taken to tackle these payments. Methods: After conducting a scoping review that involved searching websites and databases and filtering with eligibility criteria and quality assessment tools, 24 relevant studies were revealed. The data were synthesized using a narrative approach that identified key concepts, types of evidence, and research gaps. Results: The number of studies of informal patient payments increased between 2002 and 2015, but evidence regarding the issues of concern is scattered across various countries. Research has reported incidents of informal patient payments on a wide scale and has described various patterns and characteristics of these payments. Although these payments have typically been small – particularly to providers in common areas of specialized medicine – evidence regarding bought and brought goods remains limited, indicating that such practices are likely even more common, of greater magnitude and perhaps more problematic than informal patient payments. Only scant research has examined the measures that are used to tackle informal patient payments. The evidence indicates that legalizing informal patient payments, introducing performance-based payment systems, strengthening reporting, changing mentalities and involving the media and the European Union (EU) or religious organizations in anti-corruption campaigns are understood as some of the possible remedies that might help reduce informal patient payments. Conclusion: Despite comprehensive evidence regarding informal patient payments, data remain scattered and contradictory, implying that informal patient payments are a complex phenomenon. Additionally, the data on bought and brought goods illustrate that not much is known about this matter. Although informal patient payments have been studied and described in several settings, there is still little research on the effectiveness of such strategies in the Western Balkans context. PMID:29179289

  7. 7 CFR 1410.43 - Method of payment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Method of payment. 1410.43 Section 1410.43... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION RESERVE PROGRAM § 1410.43 Method... or other methods of payment in accordance with part 1401 of this chapter, unless otherwise specified...

  8. Optimizing claims payment for successful risk management.

    PubMed

    Frates, Janice; Ginty, Mary Jo; Baker, Linda

    2002-05-01

    Disputed claims and delayed payments are among the principal sources of provider and vendor dissatisfaction with managed care payment systems. Timely and accurate claims-payment systems are essential to ensure provider and vendor satisfaction, fiscal stability, and regulatory compliance. A focused analysis of conditions contributing to late payment of claims can disclose problems in provider, vendor, or payer operational and billing procedures, contracting processes, information systems, or human resources management. Resolution of these conditions equips claims-processing staff with tools to resolve problem claims promptly, thereby lowering costs.

  9. 48 CFR 3432.170 - Method of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Method of payment. 3432.170 Section 3432.170 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING General 3432.170 Method of payment. The...

  10. 42 CFR 414.313 - Initial method of payment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Initial method of payment. 414.313 Section 414.313... of Reasonable Charges Under the ESRD Program § 414.313 Initial method of payment. (a) Basic rule. Under this method, the intermediary pays the facility for routine professional services furnished by...

  11. Hospital cost control in Norway: a decade's experience with prospective payment.

    PubMed Central

    Crane, T S

    1985-01-01

    Under Norway's prospective payment system, which was in existence from 1972 to 1980, hospital costs increased 15.8 percent annually, compared with 15.3 percent in the United States. In 1980 the Norwegian national government started paying for all institutional services according to a population-based, morbidity-adjusted formula. Norway's prospective payment system provides important insights into problems of controlling hospital costs despite significant differences, including ownership of medical facilities and payment and spending as a percent of GNP. Yet striking similarities exist. Annual real growth in health expenditures from 1972 to 1980 in Norway was 2.2 percent, compared with 2.4 percent in the United States. In both countries, public demands for cost control were accompanied by demands for more services. And problems of geographic dispersion of new technology and distribution of resources were similar. Norway's experience in the 1970s demonstrates that prospective payment is no panacea. The annual budget process created disincentives to hospitals to control costs. But Norway's changes in 1980 to a population-based methodology suggest a useful approach to achieve a more equitable distribution of resources. This method of payment provides incentives to control variations in both admissions and cost per case. In contrast, the Medicare approach based on Diagnostic Related Groups (DRGs) is limited, and it does not affect variations in admissions and capital costs. Population-based methodologies can be used in adjusting DRG rates to control both problems. In addition, the DRG system only applies to Medicare payments; the Norwegian experience demonstrates that this system may result in significant shifting of costs onto other payors. PMID:3927385

  12. A usability evaluation of Lazada mobile application

    NASA Astrophysics Data System (ADS)

    Hussain, Azham; Mkpojiogu, Emmanuel O. C.; Jamaludin, Nur Hafiza; Moh, Somia T. L.

    2017-10-01

    This paper reports on a usability evaluation of Lazada mobile application, an online shopping app for mobile devices. The evaluation was conducted using 12 users of ages 18 to 24. Seven (7) were expert users and the other 5 were novice users. The study objectives were to evaluate the perceived effectiveness, efficiency and satisfaction of the mobile application. The result provides a positive feedback and shows that the mobile shopping app is effective, efficient, and satisfying as perceived by the study participants. However, there are some observed usability issues with the main menu and the payment method that necessitates improvements to increase the application's effectiveness, efficiency and satisfaction. The suggested improvements include: 1) the main menu should be capitalized and place on the left side of mobile app and 2) payment method tutorial should be included as a hyperlink in the payment method page. This observation will be helpful to the owners of the application in future version development of the app.

  13. How recalibration method, pricing, and coding affect DRG weights

    PubMed Central

    Carter, Grace M.; Rogowski, Jeannette A.

    1992-01-01

    We compared diagnosis-related group (DRG) weights calculated using the hospital-specific relative-value (HSR V) methodology with those calculated using the standard methodology for each year from 1985 through 1989 and analyzed differences between the two methods in detail for 1989. We provide evidence suggesting that classification error and subsidies of higher weighted cases by lower weighted cases caused compression in the weights used for payment as late as the fifth year of the prospective payment system. However, later weights calculated by the standard method are not compressed because a statistical correlation between high markups and high case-mix indexes offsets the cross-subsidization. HSR V weights from the same files are compressed because this methodology is more sensitive to cross-subsidies. However, both sets of weights produce equally good estimates of hospital-level costs net of those expenses that are paid by outlier payments. The greater compression of the HSR V weights is counterbalanced by the fact that more high-weight cases qualify as outliers. PMID:10127456

  14. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study.

    PubMed

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-04-01

    When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people's behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. With regard to the current challenges in Iran's health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system's features. However, future research should focus on the development of the risk-adjusted capitation model.

  15. Enforcing prompt-payment regulations: the Texas approach.

    PubMed

    McCoy, Jim E; Han, Michael C; Malloy, Michael S

    2002-07-01

    To ensure that insurance carriers pay providers in a timely manner, Texas has adopted strict payment regulations. Enforcement of the regulations has led to restitution payments for many providers. However, issues such as clean claims, underpayment, discrepancies in payment dates, and self-funded claims continue to present challenges.

  16. 42 CFR 414.313 - Initial method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Initial method of payment. 414.313 Section 414.313... Charges Under the ESRD Program § 414.313 Initial method of payment. (a) Basic rule. Under this method, the... vaccine. (c) Physician election of the initial method. (1) Each physician in a facility must submit to the...

  17. Calculating five types of typical underpayments.

    PubMed

    Welter, T; Stevenson, P

    2001-10-01

    Underpayments to providers under their payer agreements are a cause of many thousands of dollars in lost revenue. Providers should devise a plan to make certain that payments made to them are accurate, on time, and adhere to other contractual obligations. The importance of developing and implementing such a plan is substantiated by the fact that nearly 100 percent of a provider's commercial business is under contract. As a starting point, providers may wish to focus on five common types of underpayments: underfunding due to late payments; fee-schedule changes that are contractually disallowed; miscalculation of performance-based bonuses and errors in risk-payment reconciliations; inappropriate denials or inappropriate downcoding of claims; and non-payments. The successful execution of a plan to identify and resolve problems and recover payments owed relies on the provider's ability to document and prove that payment is due.

  18. No Pipe Dream: Achieving Care That Is Accountable for Cost, Quality, and Outcomes.

    PubMed

    Terrell, Grace E

    2016-01-01

    The April 2015 passage of the Medicare Access and Children's Health Insurance Program Reauthorization Act is accelerating the move of the US health care industry from traditional fee-for-service provider payments to alternative payment methods that are focused on value rather than volume of services. Medicaid, private employers, and consumer groups are also developing similar payment models. Learning from the experience of the 27 early accountable care organizations in North Carolina, such as Cornerstone Health Care, will help to accelerate the transformation that will be necessary across the health care delivery ecosystem in our state. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

  19. 31 CFR 353.31 - Series HH bonds.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... address provided to the Bureau. Deposit account information for ACH payments shall be provided on the form... 355. (f) Payment of interest by the ACH method—(1) Submission of deposit account information. Payments... submission of deposit account information, it is determined that ACH payments cannot be accepted by the...

  20. 48 CFR 52.232-40 - Providing Accelerated Payments to Small Business Subcontractors.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Payments to Small Business Subcontractors. 52.232-40 Section 52.232-40 Federal Acquisition Regulations... CLAUSES Text of Provisions and Clauses 52.232-40 Providing Accelerated Payments to Small Business... Contractor shall make accelerated payments to its small business subcontractors under this contract, to the...

  1. A New Culture of Transparency: Industry Payments to Orthopedic Surgeons.

    PubMed

    Lopez, Joseph; Ahmed, Rizwan; Bae, Sunjae; Hicks, Caitlin W; El Dafrawy, Mostafa; Osgood, Greg M; Segev, Dorry L

    2016-11-01

    Under the Physician Payments Sunshine Act, "payments or transfers of value" by biomedical companies to physicians must be disclosed through the Open Payments Program. Designed to provide transparency of financial transactions between medication and device manufacturers and health care providers, the Open Payments Program shows financial relationships between industry and health care providers. Awareness of this program is crucial because its interpretation or misinterpretation by patients, physicians, and the general public can affect patient care, clinical practice, and research. This study evaluated nonresearch payments by industry to orthopedic surgeons. A retrospective cross-sectional review of the first wave of Physician Payments Sunshine Act data (August through December 2013) was performed to characterize industry payments to orthopedic surgeons by subspecialty, amount, type, origin, and geographic distribution. During this 5-month period, orthopedic surgeons (n=14,828) received $107,666,826, which included 3% of those listed in the Open Payments Program and 23% of the total amount paid. Of orthopedic surgeons who received payment, 45% received less than $100 and 1% received $100,000 or more. Median payment (interquartile range) was $119 ($34-$636), and mean payment was $7261±95,887. The largest payment to an individual orthopedic surgeon was $7,849,711. The 2 largest payment categories were royalty or license fees (68%) and consulting fees (13%). During the study period, orthopedic surgeons had substantial financial ties to industry. Of orthopedic surgeons who received payments, the largest proportion (45%) received less than $100 and only 1% received large payments (≥$100,000). The Open Payments Program offers insight into industry payments to orthopedic surgeons. [Orthopedics. 2016; 39(6):e1058-e1062.]. Copyright 2016, SLACK Incorporated.

  2. 26 CFR 1.451-5 - Advance payments for goods and long-term contracts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... accounting for tax purposes if such method results in including advance payments in gross receipts no later... the case of a taxpayer accounting for advance payments for tax purposes pursuant to a long-term contract method of accounting under § 1.460-4, or of a taxpayer accounting for advance payments with...

  3. 24 CFR 203.400 - Method of payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Method of payment. 203.400 Section 203.400 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Payment of Insurance Benefits § 203.400 Method...

  4. 24 CFR 203.400 - Method of payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Method of payment. 203.400 Section 203.400 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued... FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Payment of Insurance Benefits § 203.400 Method...

  5. Did Budget Cuts in Medicaid Disproportionate Share Hospital Payment Affect Hospital Quality of Care?

    PubMed Central

    Hsieh, Hui-Min; Bazzoli, Gloria J.; Chen, Hsueh-Fen; Stratton, Leslie S.; Clement, Dolores G.

    2014-01-01

    Background Medicaid Disproportionate Share Hospital (DSH) payments are one of the major sources of financial support for hospitals providing care to low-income patients. However, Medicaid DSH payments will be redirected from hospitals to subsidize individual health insurance purchase through US national health reform. Objectives The purpose of this study is to examine the association between Medicaid DSH payment reductions and nursing-sensitive and birth-related quality of care among Medicaid/uninsured and privately insured patients. Research Design and Method Economic theory of hospital behavior was used as a conceptual framework, and longitudinal data for California hospitals for 1996–2003 were examined. Hospital fixed effects regression models were estimated. The unit of analysis is at the hospital-level, examining two aggregated measures based on the payer category of discharged patients (i.e., Medicaid/uninsured and privately insured). Principal Findings The overall study findings provide at best weak evidence of an association between net Medicaid DSH payments and hospital quality of care for either Medicaid/uninsured or the privately insured patients. The magnitudes of the effects are small and only a few have significant DSH effects. Conclusions Although this study does not find evidence suggesting that reducing Medicaid DSH payments had a strong negative impact on hospital quality of care for Medicaid/uninsured or privately insured patients, the results are not necessarily predictive of the impact national health care reform will have. Research is necessary to monitor hospital quality of care as this reform is implemented. PMID:24714580

  6. 46 CFR Sec. 4 - Method of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AGENTS IN PREPARATION OF INVOICES AND PAYMENT OF COMPENSATION PURSUANT TO PROVISIONS OF NSA ORDER NO. 47 Sec. 4 Method of payment. The General Agent shall prepare check drawn on the NSA Special bank account...

  7. 46 CFR Sec. 4 - Method of payment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... AGENTS IN PREPARATION OF INVOICES AND PAYMENT OF COMPENSATION PURSUANT TO PROVISIONS OF NSA ORDER NO. 47 Sec. 4 Method of payment. The General Agent shall prepare check drawn on the NSA Special bank account...

  8. 46 CFR Sec. 4 - Method of payment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... AGENTS IN PREPARATION OF INVOICES AND PAYMENT OF COMPENSATION PURSUANT TO PROVISIONS OF NSA ORDER NO. 47 Sec. 4 Method of payment. The General Agent shall prepare check drawn on the NSA Special bank account...

  9. 46 CFR Sec. 4 - Method of payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... AGENTS IN PREPARATION OF INVOICES AND PAYMENT OF COMPENSATION PURSUANT TO PROVISIONS OF NSA ORDER NO. 47 Sec. 4 Method of payment. The General Agent shall prepare check drawn on the NSA Special bank account...

  10. Teledermatology in the United States: An Update in a Dynamic Era.

    PubMed

    Yim, Kaitlyn M; Florek, Aleksandra G; Oh, Dennis H; McKoy, Karen; Armstrong, April W

    2018-01-22

    Teledermatology is rapidly advancing in the United States. The last comprehensive survey of U.S. teledermatology programs was conducted in 2011. This article provides an update regarding the state of teledermatology programs in the United States. Active programs were identified and surveyed from November 2014 to January 2017. Findings regarding practice settings, consult volumes, payment methods, and delivery modalities were compared to those from the 2011 survey. Findings from the Veterans Affairs (VA) were reported as an aggregate. There were 40 active nongovernmental programs, amounting to a 48% increase and 30% discontinuation rate over five years. Academia remained the most common practice setting (50%). Median annual consultation volume was comparable with 263 consultations, but maximum annual consultation volume increased (range: 20-20,000). The most frequent payment method was self-pay (53%). Store-and-forward continued to be the most common delivery modality. In Fiscal Year 2016, the VA System consisted of 62 consultation sites and performed a total of 101,507 consultations. The limitations of this study were that consult volume and payment methods were not available from all programs. U.S. teledermatology programs have increased in number and annual consultation volume. Academia is the most prevalent practice setting, and self-pay is the dominant accepted payment method. Innovative platforms and the provision of direct-to-patient care are changing the practice of teledermatology.

  11. Variation in payments for spine surgery episodes of care: implications for episode-based bundled payment.

    PubMed

    Kahn, Elyne N; Ellimoottil, Chandy; Dupree, James M; Park, Paul; Ryan, Andrew M

    2018-05-25

    OBJECTIVE Spine surgery is expensive and marked by high variation across regions and providers. Bundled payments have potential to reduce unwarranted spending associated with spine surgery. This study is a cross-sectional analysis of commercial and Medicare claims data from January 2012 through March 2015 in the state of Michigan. The objective was to quantify variation in payments for spine surgery in adult patients, document sources of variation, and determine influence of patient-level, surgeon-level, and hospital-level factors. METHODS Hierarchical regression models were used to analyze contributions of patient-level covariates and influence of individual surgeons and hospitals. The primary outcome was price-standardized 90-day episode payments. Intraclass correlation coefficients-measures of variability accounted for by each level of a hierarchical model-were used to quantify sources of spending variation. RESULTS The authors analyzed 17,436 spine surgery episodes performed by 195 surgeons at 50 hospitals. Mean price-standardized 90-day episode payments in the highest spending quintile exceeded mean payments for episodes in the lowest cost quintile by $42,953 (p < 0.001). Facility payments for index admission and post-discharge payments were the greatest contributors to overall variation: 39.4% and 32.5%, respectively. After accounting for patient-level covariates, the remaining hospital-level and surgeon-level effects accounted for 2.0% (95% CI 1.1%-3.8%) and 4.0% (95% CI 2.9%-5.6%) of total variation, respectively. CONCLUSIONS Significant variation exists in total episode payments for spine surgery, driven mostly by variation in post-discharge and facility payments. Hospital and surgeon effects account for relatively little of the observed variation.

  12. 37 CFR 2.207 - Methods of payment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Methods of payment. 2.207 Section 2.207 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Fees and Payment of Money in Trademark Cases § 2.207 Methods...

  13. 46 CFR Sec. 4 - Method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Method of payment. Sec. 4 Section 4 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY PROCEDURE TO BE FOLLOWED BY GENERAL... Sec. 4 Method of payment. The General Agent shall prepare check drawn on the NSA Special bank account...

  14. 34 CFR 300.103 - FAPE-methods and payments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false FAPE-methods and payments. 300.103 Section 300.103 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION... CHILDREN WITH DISABILITIES State Eligibility Other Fape Requirements § 300.103 FAPE—methods and payments...

  15. Effects of Payment Changes on Trends in Post-Acute Care

    PubMed Central

    Buntin, Melinda Beeuwkes; Colla, Carrie Hoverman; Escarce, José J

    2009-01-01

    Objective To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Data Sources Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. Study Design We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems. Data Extraction Methods A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement. Principal Findings Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill. Conclusions Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites. PMID:19490159

  16. New payment model for rural health services in Mongolia.

    PubMed

    Hindle, Don; Khulan, Buyankhishig

    2006-01-01

    This article describes experiences in Mongolia in designing and implementing a new method of payment for rural health services. The new method involves using a formula that allocates 65% of available funding on the basis of risk-adjusted capitation, 20% on the basis of asset costs, 10% on the basis of variations in distance-related costs, and 5% on the basis of satisfactory attainment of quality of care targets. Rural populations have inferior health services in most countries, whether rich or poor. Their situation has deteriorated in most transition economies, including Mongolia since 1990. One factor has been the use of inappropriate methods of payment of care providers. Changes in payment methods have therefore been made in most transition economies with mixed success. One factor has been a tendency to over-simplify, for example, to introduce capitation without risk adjustment or to make per case payments that ignored casemix. In 2002, the Mongolian government decided that its crude funding formula for rural health services should be replaced. It had two main components. The first was payment of an annual grant by the local government from its general revenue on the basis of estimated service population, number of inpatient beds, and number of clinical staff. The second was an output-based payment per inpatient day from the National Health Insurance Fund. The model was administratively complicated, and widely believed to be unfair. The two funding agencies were giving conflicting types of financial incentives. Most important, the funding methods gave few incentives or rewards for service improvement. In some respects, the incentives were perverse (such as the encouragement of hospital admission by the National Health Insurance Fund). A new funding model was developed through statistical analysis of data from routine service reports and opinions questionnaires. As noted above, there are components relating to per capita needs for care, capital assets, distance, and quality of care. The risk-adjusted capitation component determines needs classes by use of age, gender, and family income. The model was accepted by all concerned parties, and steps are now being taken to implement it under transitional arrangements. Many of the data used to parameterize the model are inaccurate and will need to be updated in the near future. However, the model is inherently valid, and procedures have been set in place that will ensure accuracy is improved on a continuing basis. An important reason why the government strongly supported implementation was its commitment to implement output-based budgeting across all government sectors. The new model provided a convenient way of applying output-based budgeting to one major component of the health sector.

  17. Medicaid nursing home payment and the role of provider taxes.

    PubMed

    Grabowski, David C; Zhanlian Feng; Mor, Vincent

    2008-08-01

    In the context of recent state budget shortfalls and the repeal of the Boren Amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. The authors examine this issue using data from a survey of state nursing home payment policies. Results indicate that aggregate inflation-adjusted Medicaid payment rates steadily increased through 2004, and this growth is partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care.

  18. Medicaid Nursing Home Payment and the Role of Provider Taxes

    PubMed Central

    Feng, Zhanlian; Intrator, Orna; Mor, Vincent

    2009-01-01

    In the context of recent state budget shortfalls and the repeal of the Boren amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. We examine this issue using data from a survey of state nursing home payment policies. Our results indicate aggregate inflation-adjusted Medicaid payment rates increased steadily through 2004, and this growth was partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care. PMID:18369236

  19. Effect of medicare payment on rural health care systems.

    PubMed

    McBride, Timothy D; Mueller, Keith J

    2002-01-01

    Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

  20. 32 CFR 203.15 - Method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 2 2011-07-01 2011-07-01 false Method of payment. 203.15 Section 203.15 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED... ACTIVITIES § 203.15 Method of payment. The SAP set forth in FAR (48 CFR part 13) require purchase orders to...

  1. 24 CFR 213.260 - Allowable methods of premium payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Allowable methods of premium payment. 213.260 Section 213.260 Housing and Urban Development Regulations Relating to Housing and Urban... Allowable methods of premium payment. Premiums shall be payable in cash or in debentures at par plus accrued...

  2. 24 CFR 213.260 - Allowable methods of premium payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Allowable methods of premium payment. 213.260 Section 213.260 Housing and Urban Development Regulations Relating to Housing and Urban... Allowable methods of premium payment. Premiums shall be payable in cash or in debentures at par plus accrued...

  3. 24 CFR 213.260 - Allowable methods of premium payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Allowable methods of premium payment. 213.260 Section 213.260 Housing and Urban Development Regulations Relating to Housing and Urban... Allowable methods of premium payment. Premiums shall be payable in cash or in debentures at par plus accrued...

  4. 24 CFR 213.260 - Allowable methods of premium payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Allowable methods of premium payment. 213.260 Section 213.260 Housing and Urban Development Regulations Relating to Housing and Urban... Allowable methods of premium payment. Premiums shall be payable in cash or in debentures at par plus accrued...

  5. 24 CFR 213.260 - Allowable methods of premium payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Allowable methods of premium payment. 213.260 Section 213.260 Housing and Urban Development Regulations Relating to Housing and Urban... Allowable methods of premium payment. Premiums shall be payable in cash or in debentures at par plus accrued...

  6. 32 CFR 203.15 - Method of payment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 2 2013-07-01 2013-07-01 false Method of payment. 203.15 Section 203.15 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED... ACTIVITIES § 203.15 Method of payment. The SAP set forth in FAR (48 CFR part 13) require purchase orders to...

  7. Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database.

    PubMed

    Jairam, Vikram; Yu, James B

    2016-01-01

    To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by provider and by transaction. Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician-industry relationships. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. 42 CFR 413.60 - Payments to providers: General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES... the provider on a cost basis, the intermediary may adjust its rate of payment to an estimate of the result under the Medicare principles of reimbursement. If no organization is paying the provider on a...

  9. The promotion of family planning by financial payments: the case of Bangladesh.

    PubMed

    Cleland, J; Mauldin, W P

    1991-01-01

    The government of Bangladesh and the World Bank commissioned a Compensation Payments Study, carried out in 1987, to assess the merits and demerits of payments for sterilizations to clients, medical personnel, and intermediaries who motivate and refer clients. The study conclusively shows that the decision of Bangladeshi men and women to undergo sterilization is a considered and voluntary act, taken in knowledge of the nature and implications of the procedure, and in knowledge of alternative methods of regulating fertility. There is a high degree of client satisfaction among those who have been sterilized, although among clients who had fewer than three children, 25 percent expressed regret that they had been sterilized. Money may be a contributing factor to the decision to become sterilized in a large majority of cases, but a dominant motive for only a very small minority. Payments to referrers have fostered a large number of unofficial, self-employed agents--particularly men who recruit vasectomy cases. These agents provide information about the procedures for being sterilized, particularly to the poor. They also concentrate on sterilizations to the exclusion of other methods, and are prone to minimize the disadvantages and exaggerate the attractions of sterilization.

  10. Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology.

    PubMed

    Cromwell, J

    1999-12-01

    As pressures to control health care costs increase, competition among physicians, advanced practice nurses, and other allied health providers has also intensified. Anesthesia care is one of the most highly contested terrains, where the growth in anesthesiologist supply has far outstripped total demand. This article explains why the supply has grown so fast despite evidence that nurse anesthetists provide equally good care at a fraction of the cost. Emphasis is given to payment incentives in the private sector and Medicare. Laudable attempts by the government to make Medicare payments more efficient and equitable by lowering the economic return to physicians specializing in anesthesia have created a hostile work environment. Nurse anesthetists are being dismissed from hospitals in favor of anesthesiologists who do not appear "on the payroll" but cost society more, nonetheless. Claims of antitrust violations by nurse anesthetists against anesthesiologists have not found much support in the courts for several reasons outlined in this essay. HMO penetration and other market forces have begun signaling new domestic physician graduates to eschew anesthesia, but, again, Medicare payment incentives encourage teaching hospitals to recruit international medical graduates to maintain graduate medical education payments. After suggesting desirable but likely ineffective reforms involving licensure laws and hospital organizational restructuring, the article discusses several alternative payment methods that would encourage hospitals and medical staffs to adopt a more cost-effective anesthesia workforce mix. Lessons for other nonphysician personnel conclude the article.

  11. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  12. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  13. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  14. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  15. 20 CFR 411.355 - What payment options does a State VR agency have?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

  16. 42 CFR 413.335 - Basis of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Facilities § 413.335 Basis of payment. (a) Method of payment. Under the prospective payment system, SNFs... and, during a transition period, on the basis of a blend of the Federal rate and the facility-specific...

  17. 42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... inpatient psychiatric facility receives payment under this subpart for inpatient operating cost and capital-related costs for each inpatient stay following submission of a bill. (b) Periodic interim payments (PIP...

  18. At first glance, informal payments experience on track: why accept or refuse? Patients' perceive in cardiac surgery department of public hospitals, northeast of Iran 2013.

    PubMed

    Vafaei Najar, Ali; Ebrahimipour, Hossein; Pourtaleb, Arefeh; Esmaily, Habibollah; Jafari, Mehdi; Nejatzadegan, Zohre; Taleghani, Yasamin Molavi

    2017-03-14

    Patient's Informal payments is among the main source of health care financing in some countries. This paper aimed at determining the patient informal payments and relative factors in Cardiac Surgery Departments (CSD) in hospitals affiliated to Mashhad University of Medical Sciences (MUMS) in 2013. In this cross-sectional study, 316 discharged patients were selected using multi-stage sampling. Data gathering tool was a questionnaire which was filled by structured telephone interviews. We used quantitative content analysis for open-ended questions besides descriptive statistics and nonparametric tests by SPSS 16 at 0.05 Sig level. Sixteen (5.93%) patients made voluntary informal payments. The purpose of payment was: "gratitude" (43.75%), satisfaction with health services provided" (31.25%) and (18.75%) for better quality of services. About 75% of the payments were occurred during receiving health care services. The main causes were "no request for informal payments" (98.14%), "not affording to pay for informal payments" (73.33%) and "paying the hospital expenses by taking out a loan" (55.91%). Responders said they would pay informally in demand situation (51.85%) just for patient's health priority, 40.71% would also "search for other alternative solutions" and 27.33% "accepted the demand as a kind of gratitude culture". Twenty four patients (8.9%) had experienced mandatory informal payments during the last 6 months. The minimum amount of payment was 62.5$ and the maximum was 3125$. There was a significant relationship between the way of referring to medical centers and informal patient's payment (P ≤0.05). Despite the widespread prevalent belief about informal payments in public hospitals -particularly to the well-known physicians - such judgment cannot be generalized. The main reasons for the low informal payments in the current study were the personality characteristics of the physicians and hospital staff, their moral conscience and commitment to professional ethics, cultural factors and social-economic status of the patients. Health care system should notify people about their rights specially the payments calculation mechanism and methods. Better communication with the public and especially the media can help to correct attitude toward these payments.

  19. The Effect of Medicaid Payment Generosity on Access and Use among Beneficiaries

    PubMed Central

    Shen, Yu-Chu; Zuckerman, Stephen

    2005-01-01

    Objective This study examines the effects of Medicaid payment generosity on access and care for adult and child Medicaid beneficiaries. Data Source Three years of the National Surveys of America's Families (1997, 1999, 2002) are linked to the Urban Institute Medicaid capitation rate surveys, the Area Resource File, and the American Hospital Association survey files. Study Design In order to identify the effect of payment generosity apart from unmeasured differences across areas, we compare the experiences of Medicaid beneficiaries with groups that should not be affected by Medicaid payment policies. To assure that these groups are comparable to Medicaid beneficiaries, we reweight the data using propensity score methods. We use a difference-in-differences model to assess the effects of Medicaid payment generosity on four categories of access and use measures (continuity of care, preventive care, visits, and perceptions of provider communication and quality of care). Principal Findings Higher payments increase the probability of having a usual source of care and the probability of having at least one visit to a doctor and other health professional for Medicaid adults, and produce more positive assessments of the health care received by adults and children. However, payment generosity has no effect on the other measures that we examined, such as the probability of receiving preventive care or the probability of having unmet needs. Conclusions Higher payment rates can improve some aspects of access and use for Medicaid beneficiaries, but the effects are not dramatic. PMID:15960688

  20. 29 CFR 1610.15 - Schedule of fees and method of payment for services rendered.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Schedule of fees and method of payment for services... of fees and method of payment for services rendered. (a) Fees shall be assessed in accordance with... request is made by an educational or noncommercial scientific institution, or a representative of the news...

  1. 24 CFR 255.6 - Method of payment of mortgage insurance premiums.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... PROJECTS § 255.6 Method of payment of mortgage insurance premiums. The provisions of 24 CFR 251.6 shall... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Method of payment of mortgage insurance premiums. 255.6 Section 255.6 Housing and Urban Development Regulations Relating to Housing and...

  2. 48 CFR 32.503-6 - Suspension or reduction of payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Progress Payments Based on Costs 32.503-6 Suspension or reduction of payments. (a) General. The Progress Payments clause provides a Government right to reduce or suspend progress payments, or to increase the liquidation rate, under specified conditions...

  3. An agent-based simulation model to study accountable care organizations.

    PubMed

    Liu, Pai; Wu, Shinyi

    2016-03-01

    Creating accountable care organizations (ACOs) has been widely discussed as a strategy to control rapidly rising healthcare costs and improve quality of care; however, building an effective ACO is a complex process involving multiple stakeholders (payers, providers, patients) with their own interests. Also, implementation of an ACO is costly in terms of time and money. Immature design could cause safety hazards. Therefore, there is a need for analytical model-based decision-support tools that can predict the outcomes of different strategies to facilitate ACO design and implementation. In this study, an agent-based simulation model was developed to study ACOs that considers payers, healthcare providers, and patients as agents under the shared saving payment model of care for congestive heart failure (CHF), one of the most expensive causes of sometimes preventable hospitalizations. The agent-based simulation model has identified the critical determinants for the payment model design that can motivate provider behavior changes to achieve maximum financial and quality outcomes of an ACO. The results show nonlinear provider behavior change patterns corresponding to changes in payment model designs. The outcomes vary by providers with different quality or financial priorities, and are most sensitive to the cost-effectiveness of CHF interventions that an ACO implements. This study demonstrates an increasingly important method to construct a healthcare system analytics model that can help inform health policy and healthcare management decisions. The study also points out that the likely success of an ACO is interdependent with payment model design, provider characteristics, and cost and effectiveness of healthcare interventions.

  4. 48 CFR 32.009 - Providing accelerated payments to small business subcontractors.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Providing accelerated payments to small business subcontractors. 32.009 Section 32.009 Federal Acquisition Regulations System... accelerated payments to small business subcontractors. ...

  5. Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

    PubMed Central

    Wittenbecher, Friedrich

    2013-01-01

    Abstract Objective This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face. Methods A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French and Spanish through Pubmed, the Pan American Health Organization’s Regional Library of Medicine and Google. Findings Twelve low- and middle-income countries have DRG-based payment systems and another 17 are in the piloting or exploratory stage. Countries have chosen from a wide range of imported and self-developed DRG models and most have adapted such models to their specific contexts. All countries have set expenditure ceilings. In general, systems were piloted before being implemented. The need to meet certain requirements in terms of coding standardization, data availability and information technology made implementation difficult. Private sector providers have not been fully integrated, but most countries have managed to delink hospital financing from public finance budgeting. Conclusion Although more evidence on the impact of DRG-based payment systems is needed, our findings suggest that (i) the greater portion of health-care financing should be public rather than private; (ii) it is advisable to pilot systems first and to establish expenditure ceilings; (iii) countries that import an existing variant of a DRG-based system should be mindful of the need for adaptation; and (iv) countries should promote the cooperation of providers for appropriate data generation and claims management. PMID:24115798

  6. Traditional Payment Models in Radiology: Historical Context for Ongoing Reform.

    PubMed

    Silva, Ezequiel; McGinty, Geraldine B; Hughes, Danny R; Duszak, Richard

    2016-10-01

    The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on quality and alternative payment model participation. The general structure of payment under MACRA is included in the statute, but the rules and regulations defining its implementation are yet to be formalized. It is imperative that the radiology profession inform policymakers on their role in health care under MACRA. This will require a detailed understanding of prior legislative and nonlegislative actions that helped shape MACRA. To that end, the authors provide a detailed historical context for payment reform, focusing on the payment quality initiatives and alternative payment model demonstrations that helped provide the foundation of future MACRA-driven payment reform. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  7. 42 CFR 438.804 - Primary care provider payment increases.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Primary care provider payment increases. 438.804 Section 438.804 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Participation § 438.804 Primary care provider payment increases. (a) For MCO, PIHP or PAHP contracts that cover...

  8. 41 CFR 304-3.15 - Must I provide my agency with information about any payment I receive on its behalf?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... with information about any payment I receive on its behalf? 304-3.15 Section 304-3.15 Public Contracts and Property Management Federal Travel Regulation System PAYMENT OF TRAVEL EXPENSES FROM A NON-FEDERAL... RESPONSIBILITY General § 304-3.15 Must I provide my agency with information about any payment I receive on its...

  9. 41 CFR 304-3.15 - Must I provide my agency with information about any payment I receive on its behalf?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... with information about any payment I receive on its behalf? 304-3.15 Section 304-3.15 Public Contracts and Property Management Federal Travel Regulation System PAYMENT OF TRAVEL EXPENSES FROM A NON-FEDERAL... RESPONSIBILITY General § 304-3.15 Must I provide my agency with information about any payment I receive on its...

  10. Achieving health care cost containment through provider payment reform that engages patients and providers.

    PubMed

    Ginsburg, Paul B

    2013-05-01

    The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

  11. Job Evaluation's Role in Employee Relations

    ERIC Educational Resources Information Center

    Dick, Arthur H.

    1974-01-01

    Jobs are evaluated to provide a fair basis for payment of wages; this procedure must be communicated to employees so they can see they are being treated equitably. Job ranking, grading or job classification, factor comparison, the point method, and direct pricing are methods used in job evaluation programs. (AG)

  12. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment...

  13. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment...

  14. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment...

  15. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment...

  16. 32 CFR 34.12 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Program Management § 34.12 Payment. (a) Methods available. Payment methods for awards with for-profit... Administration Services Components,” DLAH 4105.4, which can be obtained from either: Defense Logistics Agency...-6220; or the Defense Contract Management Command home page at http://www.dcmc.dcrb.dla.mil. 2 See...

  17. 42 CFR 495.310 - Medicaid provider incentive payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Medicaid EP or eligible hospital may receive an incentive payment from only one State in a payment year. (f) Incentive payments to hospitals. Incentive payments to an eligible hospital under this subpart are subject... hospital incentive amount calculated under paragraph (g) of this section for an individual hospital. (4) No...

  18. Optimizing revenue at a cosmetic surgery centre

    PubMed Central

    Funk, Joanna M; Verheyden, Charles N; Mahabir, Raman C

    2011-01-01

    BACKGROUND: The demand for cosmetic surgery and services has diminished with recent fluctuations in the economy. To stay ahead, surgeons must appreciate and attend to the fiscal challenges of private practice. A key component of practice economics is knowledge of the common methods of payment. OBJECTIVE: To review methods of payment in a five-surgeon group practice in central Texas, USA. METHODS: A retrospective chart review of the financial records of a cosmetic surgery centre in Texas was conducted. Data were collected for the five-year period from 2003 to 2008, and included the method of payment, the item purchased (product, service or surgery) and the dollar amount. RESULTS: More than 11,000 transactions were reviewed. The most common method of payment used for products and services was credit card, followed by check and cash. For procedures, the most common form of payment was personal check, followed by credit card and financing. Of the credit card purchases for both products and procedures, an overwhelming majority of patients (more than 75%) used either Visa (Visa Inc, USA) or MasterCard (MasterCard Worldwide, USA). If the amount of the individual transaction surpassed US$1,000, the most common method of payment transitioned from credit card to personal check. CONCLUSIONS: In an effort to maximize revenue, surgeons should consider limiting the credit cards accepted by the practice and encourage payment through personal check. PMID:22942656

  19. 31 CFR 256.11 - How do agencies request payments?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... request forms or by using other approved methods as provided for on the Judgment Fund Web site at http://www.fiscal.treasury.gov/judgefund. Fiscal Service provides forms and detailed information about... Judgment Fund Web site. The submitting agency must complete and sign all required Judgment Fund forms and...

  20. The Case for Capitation.

    PubMed

    James, Brent C; Poulsen, Gregory P

    2016-01-01

    Recent studies suggest that at least 35%--and maybe over 5o%--of all health care spending in the U.S. is wasted on inadequate, unnecessary, and inefficient care and suboptimal business processes. But efforts to get rid of that waste face a huge challenge: Under current payment methods, the providers who develop more-cost-effective approaches don't receive any of the savings. Instead, the money goes mainly to insurers. The providers, who are paid for the volume of services delivered, end up actually losing money, which undermines their finances and their ability to invest in more cost-saving innovations. To address this quandary, say two top execs from the nonprofit Intermountain Healthcare system, we need a different way to pay for health care: population-based payment. PBP gives care delivery groups a fixed per-person payment that covers all of an individual's health care services in a given year. Under it, providers benefit from the savings of all efforts to attack waste, encouraging them to do it more. And though PBP may sound similar to the HMOs of the 1990s, there are significant twists: Payments go directly to care delivery groups, and patients' physicians--not insurance companies--assume responsibility for overseeing and managing the cost of treatment. Provider groups are also required to meet quality standards that further protect patients. By applying PBP in just part of its system, Intermountain, which serves 2 million people, has been able to chop $688 million in annual waste and bring total costs down 13%.

  1. Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

    PubMed

    Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

    2014-09-01

    In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a "burning bridge" between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of "reformed" fee-for-service with bundled payments and global payments. © 2014 Milbank Memorial Fund.

  2. 42 CFR 412.632 - Method of payment under the inpatient rehabilitation facility prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... and for costs of an approved education program and other costs paid outside the prospective payment... must be approved by the intermediary and us. (3) Amount of payment. The amount of the accelerated...

  3. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods...

  4. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods...

  5. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods...

  6. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods...

  7. 29 CFR 95.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... and Human Services, Payment Management System, P.O. Box 6021, Rockville, MD 20852. Interest amounts up... FOREIGN GOVERNMENTS, AND INTERNATIONAL ORGANIZATIONS Post-Award Requirements Financial and Program Management § 95.22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of...

  8. 7 CFR 215.5 - Method of payment to States.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.5 Method of payment to States. (a... Authorities and child-care institutions through presentation by designated State officials of a Payment... delay for the purpose for which drawn. Notwithstanding the foregoing provisions, if funds are made...

  9. 76 FR 50949 - Withholding on Payments by Government Entities to Persons Providing Property or Services; Hearing

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-17

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 31 [REG-151687-10] RIN 1545-BJ98 Withholding on Payments by Government Entities to Persons Providing Property or Services; Hearing AGENCY... government entities on payments to persons providing property or services. DATES: The public hearing is being...

  10. 17 CFR 229.1114 - (Item 1114) Credit enhancement and other support, except for certain derivatives instruments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... liable to provide payments representing 10% or more of the cash flow supporting any offered class of... liable to provide payments representing 10% or more, but less than 20%, of the cash flow supporting any... liable or contingently liable to provide payments representing 20% or more of the cash flow supporting...

  11. 42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Recovery of accelerated payment. Recovery of the accelerated payment is made by recoupment as inpatient... cost report settlement specified in § 412.84(i) and § 412.84(m) of this part. (e) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient psychiatric...

  12. 42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Recovery of accelerated payment. Recovery of the accelerated payment is made by recoupment as inpatient... cost report settlement specified in § 412.84(i) and § 412.84(m) of this part. (e) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient psychiatric...

  13. 42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Recovery of accelerated payment. Recovery of the accelerated payment is made by recoupment as inpatient... cost report settlement specified in § 412.84(i) and § 412.84(m) of this part. (e) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient psychiatric...

  14. 42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Recovery of accelerated payment. Recovery of the accelerated payment is made by recoupment as inpatient... cost report settlement specified in § 412.84(i) and § 412.84(m) of this part. (e) Accelerated payments—(1) General rule. Upon request, an accelerated payment may be made to an inpatient psychiatric...

  15. Capital financing in prospective payment.

    PubMed

    Oszustowicz, R J; Dreachslin, J L

    1984-03-01

    In the era of prospective payment, arranging financing for hospital capital projects is expected to become even more complicated than under cost-based reimbursement systems. This article outlines the information needed for a bond issue in the prospective payment environment, defines the roles and duties of several external persons and organizations involved with planning a major capital financing, and provides an overview of the entire process. This article assumes for illustrative purposes that a tax-exempt bond issue is going to be used to finance a facility expansion. This method was chosen since over 70% of all major capital financing for hospitals use the tax-exempt bond as the principal vehicle for attracting the necessary debt to finance a major construction project. The tax-exempt bond issue also requires the most detail in documentation and legal provisions.

  16. 26 CFR 1.6050W-1 - Information reporting for payments made in settlement of payment card and third party network...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... persons for the cost of membership in Y. Separately, A pays healthcare providers pursuant to provider... traditional check, not as a payment card. Example 17. Healthcare network. Health carrier A operates healthcare...

  17. 24 CFR 206.26 - Change in payment option.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Change in payment option. 206.26... in payment option. (a) General. The payment option may be changed as provided in this section. (b... credit payment option. Until the repairs are completed, the mortgagee shall make no line of credit...

  18. 15 CFR 14.22 - Payment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... transfer of funds and disbursement by the recipient, and financial management systems that meet the... accounts shall be remitted annually to Department of Health and Human Services, Payment Management System... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods...

  19. 15 CFR 14.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... transfer of funds and disbursement by the recipient, and financial management systems that meet the... accounts shall be remitted annually to Department of Health and Human Services, Payment Management System... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods...

  20. 45 CFR 2543.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... and disbursement by the recipient, and (2) Financial management systems that meet the standards for... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Requirements Financial and Program Management § 2543.22 Payment. (a) Payment methods shall minimize the time...

  1. 15 CFR 14.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... transfer of funds and disbursement by the recipient, and financial management systems that meet the... accounts shall be remitted annually to Department of Health and Human Services, Payment Management System... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods...

  2. 45 CFR 2543.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... and disbursement by the recipient, and (2) Financial management systems that meet the standards for... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Requirements Financial and Program Management § 2543.22 Payment. (a) Payment methods shall minimize the time...

  3. 20 CFR 435.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., and (ii) Financial management systems that meet the standards for fund control and accountability as..., Payment Management System, Rockville, MD 20852. Interest amounts up to $250 per year may be retained by...-Award Requirements Financial and Program Management § 435.22 Payment. (a) Introduction. Payment methods...

  4. 45 CFR 2543.22 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and disbursement by the recipient, and (2) Financial management systems that meet the standards for... remitted annually to Department of Health and Human Services, Payment Management System, Rockville, MD... Requirements Financial and Program Management § 2543.22 Payment. (a) Payment methods shall minimize the time...

  5. Benefits in Cash or in Kind? A Community Consultation on Types of Benefits in Health Research on the Kenyan Coast

    PubMed Central

    Njue, Maureen; Molyneux, Sassy; Kombe, Francis; Mwalukore, Salim; Kamuya, Dorcas; Marsh, Vicki

    2015-01-01

    Background Providing benefits and payments to participants in health research, either in cash or in kind, is a common but ethically controversial practice. While much literature has concentrated on appropriate levels of benefits or payments, this paper focuses on less well explored ethical issues around the nature of study benefits, drawing on views of community members living close to an international health research centre in Kenya. Methods The consultation, including 90 residents purposively chosen to reflect diversity, used a two-stage deliberative process. Five half-day workshops were each followed by between two and four small group discussions, within a two week period (total 16 groups). During workshops and small groups, facilitators used participatory methods to share information, and promote reflection and debate on ethical issues around types of benefits, including cash, goods, medical and community benefits. Data from workshop and field notes, and voice recordings of small group discussions, were managed using Nvivo 10 and analysed using a Framework Analysis approach. Findings and Conclusions The methods generated in-depth discussion with high levels of engagement. Particularly for the most-poor, under-compensation of time in research carries risks of serious harm. Cash payments may best support compensation of costs experienced; while highly valued, goods and medical benefits may be more appropriate as an ‘appreciation’ or incentive for participation. Community benefits were seen as important in supporting but not replacing individual-level benefits, and in building trust in researcher-community relations. Cash payments were seen to have higher risks of undue inducement, commercialising relationships and generating family conflicts than other benefits, particularly where payments are high. Researchers should consider and account for burdens families may experience when children are involved in research. Careful context-specific research planning and skilled and consistent communication about study benefits and payments are important, including in mitigating potential negative effects. PMID:26010783

  6. Opportunities and Challenges for Payment Reform: Observations from Massachusetts.

    PubMed

    Mechanic, Robert E

    2016-08-01

    Policy makers and private health plans are expanding their efforts to implement new payment models that will encourage providers to improve quality and deliver health care more efficiently. Over the past five years, payment reforms have progressed faster in Massachusetts than in any other state. The reasons include a major effort by Blue Cross Blue Shield of Massachusetts to implement global payment, the presence of large integrated systems willing to take on financial risk, and a supportive state policy environment. By 2014, thirty-seven percent of Massachusetts's residents enrolled in health plans were covered under risk-based payment models tied to global budgets. But the expansion of payment reform in Massachusetts slowed between 2012 and 2015 because some commercial enrollment shifted from risk-based health maintenance organization products to fee-for-service preferred provider organization (PPO) plans, and the state Medicaid program fell short of its payment reform goals. Provider groups will not fully commit to population-based clinical models if they believe it will result in large reductions in fee-for-service revenue. The use of alternative payment models will accelerate in 2016 when Blue Cross begins implementing PPO payment reforms, but it is unknown how quickly other payers will follow. Massachusetts's experience illustrates the complexity of payment reform in pluralistic health care markets and the need for complementary efforts by public and private stakeholders. Copyright © 2016 by Duke University Press.

  7. 34 CFR 74.22 - Payment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... recipient; and (ii) Financial management systems that meet the standards for fund control and accountability... Human Services, Payment Management System, Rockville, MD 20852. Interest amounts up to $250 per year may... Management § 74.22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of...

  8. 34 CFR 74.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... recipient; and (ii) Financial management systems that meet the standards for fund control and accountability... Human Services, Payment Management System, Rockville, MD 20852. Interest amounts up to $250 per year may... Management § 74.22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of...

  9. 20 CFR 411.582 - Can a State VR agency receive payment under the cost reimbursement payment system if a continuous...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Can a State VR agency receive payment under... Systems § 411.582 Can a State VR agency receive payment under the cost reimbursement payment system if a...? Yes. If a State VR agency provides services to a beneficiary under 34 CFR part 361, and elects payment...

  10. 20 CFR 411.582 - Can a State VR agency receive payment under the cost reimbursement payment system if a continuous...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Can a State VR agency receive payment under... Systems § 411.582 Can a State VR agency receive payment under the cost reimbursement payment system if a...? Yes. If a State VR agency provides services to a beneficiary under 34 CFR part 361, and elects payment...

  11. 20 CFR 411.582 - Can a State VR agency receive payment under the cost reimbursement payment system if a continuous...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Can a State VR agency receive payment under... Systems § 411.582 Can a State VR agency receive payment under the cost reimbursement payment system if a...? Yes. If a State VR agency provides services to a beneficiary under 34 CFR part 361, and elects payment...

  12. 20 CFR 411.582 - Can a State VR agency receive payment under the cost reimbursement payment system if a continuous...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Can a State VR agency receive payment under... Systems § 411.582 Can a State VR agency receive payment under the cost reimbursement payment system if a...? Yes. If a State VR agency provides services to a beneficiary under 34 CFR part 361, and elects payment...

  13. 20 CFR 411.582 - Can a State VR agency receive payment under the cost reimbursement payment system if a continuous...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Can a State VR agency receive payment under... Systems § 411.582 Can a State VR agency receive payment under the cost reimbursement payment system if a...? Yes. If a State VR agency provides services to a beneficiary under 34 CFR part 361, and elects payment...

  14. How will provider-focused payment reform impact geographic variation in Medicare spending?

    PubMed

    Auerbach, David; Mehrotra, Ateev; Hussey, Peter; Huckfeldt, Peter J; Alpert, Abby; Lau, Christopher; Shier, Victoria

    2015-06-01

    The Institute of Medicine has recently argued against a value index as a mechanism to address geographic variation in spending and instead promoted payment reform targeted at individual providers. It is unknown whether such provider-focused payment reform reduces geographic variation in spending. We estimated the potential impact of 3 Medicare provider-focused payment policies-pay-for-performance, bundled payment, and accountable care organizations-on geographic variation in Medicare spending across Hospital Referral Regions (HRRs). We compared geographic variation in spending, measured using the coefficient of variation (CV) across HRRs, between the baseline case and a simulation of each of the 3 policies. Policy simulation based on 2008 national Medicare data combined with other publicly available data. Compared with the baseline (CV, 0.171), neither pay-for-performance nor accountable care organizations would change geographic variation in spending (CV, 0.171), while bundled payment would modestly reduce geographic variation (CV, 0.165). In our models, the bundled payment for inpatient and post acute care services in Medicare would modestly reduce geographic variation in spending, but neither accountable care organizations nor pay-for-performance appear to have an impact.

  15. 31 CFR 363.125 - How is payment made on a book-entry savings bond?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false How is payment made on a book-entry... GOVERNING SECURITIES HELD IN TREASURYDIRECT Book-Entry Savings Bonds Purchased Through TreasuryDirect Payment § 363.125 How is payment made on a book-entry savings bond? We will make payment by the ACH method...

  16. 31 CFR 363.125 - How is payment made on a book-entry savings bond?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false How is payment made on a book-entry... GOVERNING SECURITIES HELD IN TREASURYDIRECT Book-Entry Savings Bonds Purchased Through TreasuryDirect Payment § 363.125 How is payment made on a book-entry savings bond? We will make payment by the ACH method...

  17. 31 CFR 363.125 - How is payment made on a book-entry savings bond?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false How is payment made on a book-entry... GOVERNING SECURITIES HELD IN TREASURYDIRECT Book-Entry Savings Bonds Purchased Through TreasuryDirect Payment § 363.125 How is payment made on a book-entry savings bond? We will make payment by the ACH method...

  18. 31 CFR 363.125 - How is payment made on a book-entry savings bond?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false How is payment made on a book-entry... GOVERNING SECURITIES HELD IN TREASURYDIRECT Book-Entry Savings Bonds Purchased Through TreasuryDirect Payment § 363.125 How is payment made on a book-entry savings bond? We will make payment by the ACH method...

  19. 31 CFR 363.125 - How is payment made on a book-entry savings bond?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false How is payment made on a book-entry... GOVERNING SECURITIES HELD IN TREASURYDIRECT Book-Entry Savings Bonds Purchased Through TreasuryDirect Payment § 363.125 How is payment made on a book-entry savings bond? We will make payment by the ACH method...

  20. Optimizing revenue at a cosmetic surgery centre.

    PubMed

    Funk, Joanna M; Verheyden, Charles N; Mahabir, Raman C

    2011-01-01

    The demand for cosmetic surgery and services has diminished with recent fluctuations in the economy. To stay ahead, surgeons must appreciate and attend to the fiscal challenges of private practice. A key component of practice economics is knowledge of the common methods of payment. To review methods of payment in a five-surgeon group practice in central Texas, USA. A retrospective chart review of the financial records of a cosmetic surgery centre in Texas was conducted. Data were collected for the five-year period from 2003 to 2008, and included the method of payment, the item purchased (product, service or surgery) and the dollar amount. More than 11,000 transactions were reviewed. The most common method of payment used for products and services was credit card, followed by check and cash. For procedures, the most common form of payment was personal check, followed by credit card and financing. Of the credit card purchases for both products and procedures, an overwhelming majority of patients (more than 75%) used either Visa (Visa Inc, USA) or MasterCard (MasterCard Worldwide, USA). If the amount of the individual transaction surpassed US$1,000, the most common method of payment transitioned from credit card to personal check. In an effort to maximize revenue, surgeons should consider limiting the credit cards accepted by the practice and encourage payment through personal check.

  1. 42 CFR 413.64 - Payments to providers: Specific rules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... small as possible. (c) Interim payments during initial reporting period. At the beginning of the program... experienced a temporary delay in preparing and submitting bills to the contractor beyond its normal billing.... Recovery of the accelerated payment may be made by recoupment as provider bills are processed or by direct...

  2. Medicare and Medicaid programs; Home Health Prospective Payment System rate update for CY 2014, home health quality reporting requirements, and cost allocation of home health survey expenses. Final rule.

    PubMed

    2013-12-02

    This final rule will update the Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, the low-utilization payment adjustment (LUPA) add-on, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective January 1, 2014. As required by the Affordable Care Act, this rule establishes rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. In addition, this final rule will remove 170 diagnosis codes from assignment to diagnosis groups within the HH PPS Grouper, effective January 1, 2014. Finally, this rule will establish home health quality reporting requirements for CY 2014 payment and subsequent years and will clarify that a state Medicaid program must provide that, in certifying HHAs, the state's designated survey agency carry out certain other responsibilities that already apply to surveys of nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), including sharing in the cost of HHA surveys. For that portion of costs attributable to Medicare and Medicaid, we will assign 50 percent to Medicare and 50 percent to Medicaid, the standard method that CMS and states use in the allocation of expenses related to surveys of nursing homes.

  3. Payment Reform to Enhance Collaboration of Primary Care and Cardiology: A Review.

    PubMed

    Farmer, Steven A; Casale, Paul N; Gillam, Linda D; Rumsfeld, John S; Erickson, Shari; Kirschner, Neil M; de Regnier, Kevin; Williams, Bruce R; Martin, R Shawn; McClellan, Mark B

    2018-01-01

    The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health reforms are needed to increase patient access, reduce costs, and improve health care quality, and the landmark Medicare Access and CHIP Reauthorization Act presents a roadmap for reform. The product of a collaboration between primary care and cardiology clinicians, this review describes a conceptual approach to delivery and payment reforms that aim to better support primary care-cardiology comanagement of chronic cardiovascular disease (CVD). Few existing alternative payment models specifically address long-term management of CVD. Primary care medical homes and accountable care organizations come closest, but both emphasize primary care, and cardiologists have often not been well engaged. A collaborative care framework should articulate distinct roles and responsibilities for primary care and cardiology in CVD comanagement. Finally, a series of payment models aim to better support clinicians in providing accountable, seamless, and patient-centered cardiac care. Clinical leadership is essential during this time of change in the health care system. Patients often struggle to navigate a fragmented and expensive system, whereas clinicians often practice with incomplete information about tests, treatments, and recommendations by their colleagues. The payment models described in this review offer an opportunity to create more satisfying approaches to patient care while improving value. These models have potential to support more effective coordination and to facilitate broader health care system transformation.

  4. 42 CFR § 414.1435 - Qualifying APM participant determination: Medicare option.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1435 Qualifying APM participant determination: Medicare option. (a) Payment amount method. The...

  5. 22 CFR 145.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Payment. 145.22 Section 145.22 Foreign....22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of funds from... request for reimbursement at least monthly when electronic funds transfers are not used. (f) If a...

  6. 22 CFR 145.22 - Payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Payment. 145.22 Section 145.22 Foreign....22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of funds from... request for reimbursement at least monthly when electronic funds transfers are not used. (f) If a...

  7. 22 CFR 145.22 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Payment. 145.22 Section 145.22 Foreign....22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of funds from... request for reimbursement at least monthly when electronic funds transfers are not used. (f) If a...

  8. 22 CFR 145.22 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Payment. 145.22 Section 145.22 Foreign....22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of funds from... request for reimbursement at least monthly when electronic funds transfers are not used. (f) If a...

  9. 42 CFR 414.313 - Initial method of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... inpatients who were not admitted solely to receive maintenance dialysis. (iv) Administration of hepatitis B... (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Determination of Reasonable... of this subchapter. (b) Services for which payment is not included in the add-on payment. (1...

  10. 42 CFR 412.116 - Method of payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as hospital bills are... made on an interim basis. (f) Accelerated payments—(1) General rule. Upon request, an accelerated... intermediary beyond its normal billing cycle. (2) Approval of payment. A hospital's request for an accelerated...

  11. 42 CFR 412.116 - Method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as hospital bills are... made on an interim basis. (f) Accelerated payments—(1) General rule. Upon request, an accelerated... intermediary beyond its normal billing cycle. (2) Approval of payment. A hospital's request for an accelerated...

  12. 42 CFR 412.116 - Method of payment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as hospital bills are... made on an interim basis. (f) Accelerated payments—(1) General rule. Upon request, an accelerated... intermediary beyond its normal billing cycle. (2) Approval of payment. A hospital's request for an accelerated...

  13. 42 CFR 412.116 - Method of payment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as hospital bills are... made on an interim basis. (f) Accelerated payments—(1) General rule. Upon request, an accelerated... intermediary beyond its normal billing cycle. (2) Approval of payment. A hospital's request for an accelerated...

  14. The March to Accountable Care Organizations--How Will Rural Fare?

    ERIC Educational Resources Information Center

    MacKinney, A. Clinton; Mueller, Keith J.; McBride, Timothy D.

    2011-01-01

    Purpose: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). Methods: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA)…

  15. 42 CFR 430.45 - Reduction of Federal Medicaid payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Reduction of Federal Medicaid payments. 430.45 Section 430.45 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Federal Medicaid Payments § 430.45 Reduction of Federal Medicaid payments. (a) Methods of reduction. CMS...

  16. 22 CFR 518.22 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Payment. 518.22 Section 518.22 Foreign Relations... and Program Management § 518.22 Payment. (a) Payment methods shall minimize the time elapsing between... reimbursement at least monthly when electronic funds are not used. (f) If a recipient cannot meet the criteria...

  17. Episodic payments (bundling): PART I.

    PubMed

    Jacofsky, D J

    2017-10-01

    Episodic, or bundled payments, is a concept now familiar to most in the healthcare arena, but the models are often misunderstood. Under a traditional fee-for-service model, each provider bills separately for their services which creates financial incentives to maximise volumes. Under a bundled payment, a single entity, often referred to as a convener (maybe the hospital, the physician group, or a third party) assumes the risk through a payer contract for all services provided within a defined episode of care, and receives a single (bundled) payment for all services provided for that episode. The time frame around the intervention is variable, but defined in advance, as are included and excluded costs. Timing of the actual payment in a bundle may either be before the episode occurs (prospective payment model), or after the end of the episode through a reconciliation (retrospective payment model). In either case, the defined costs over the defined time frame are borne by the convener. Cite this article: Bone Joint J 2017;99-B:1280-5. ©2017 The British Editorial Society of Bone & Joint Surgery.

  18. Final inpatient rehabilitation PPS rule improves on proposed rule.

    PubMed

    Reynolds, M

    2001-10-01

    On August 7, 2001, the Centers for Medicare and Medicaid Services (CMS--formerly HCFA) released the final rule for a new prospective payment system (PPS) for inpatient rehabilitation services describing the process that must be used to receive payment for such services provided to Medicare beneficiaries. The process consists of five steps: First, a clinician performs assessments of the patient upon admission and at discharge. Second, the patient is classified into a case-mix group (CMG) with an assigned relative-value weight within that CMG. Third, the Federal prospective payment rate is determined by multiplying the relative-value weight by an annually updated, budget-neutral conversion factor. Fourth, the Federal prospective payment rate is adjusted to account for facility-specific factors. Finally, the facility-adjusted payment rate may be adjusted for case-specific factors. The final rule eliminates three deficiencies in the proposed rule by providing increased payment for treating any comorbidities documented prior to the second day before discharge, providing more appropriate payment for transfer cases, and minimizing the paperwork associated with patient assessment.

  19. 20 CFR 627.305 - Payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Federal or federally assisted program based on need, other than as provided under the Social Security Act... are: Needs-based payments for eligible individuals in programs under title II; incentive and bonus payments for participants in title II programs; work-based training payments for work experience, entry...

  20. 10 CFR 603.815 - Withholding payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Withholding payments. 603.815 Section 603.815 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Award Terms Related to Other Administrative Matters Payments § 603.815 Withholding payments. A TIA must provide that the...

  1. 43 CFR 5461.1 - Payment in advance of cutting or removal.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Payment in advance of cutting or removal... Payments § 5461.1 Payment in advance of cutting or removal. Except as provided in §§ 5451.2 and 5451.4 no part of any timber or other vegetative resources sold may be cut or removed unless advance payment has...

  2. Bundled payment and enhanced recovery after surgery.

    PubMed

    Huang, Jeffrey

    2015-01-01

    Medicare's fee-for-service (FFS) payment model may contribute to unsustainable spending growth. Payers are turning to alternative payment methods. The leading alternative payment model to the FFS problem is bundled payment. The Centers for Medicare & Medicaid Services (CMS) is taking another step to improve healthcare quality at lower cost. The CMS's Center for Medicare and Medicaid Innovation developed four models of bundled payments and 48 discrete clinical condition episodes. Many surgical care procedures are included in the 48 different clinical condition episodes.

  3. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

    PubMed

    2016-11-14

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

  4. Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

    PubMed

    Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

    2015-01-01

    With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.

  5. 42 CFR 414.58 - Payment of charges for physician services to patients in providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment of charges for physician services to patients in providers. 414.58 Section 414.58 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER...

  6. 42 CFR 495.320 - FFP for payments to Medicaid providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false FFP for payments to Medicaid providers. 495.320 Section 495.320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.320 FFP for payments to Medicaid...

  7. 12 CFR 552.14 - Dissenter and appraisal rights.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... demand payment of fair or appraised value. Except as provided in paragraph (b) of this section, any... right to demand payment of the fair or appraised value of his stock: Provided, That such stockholder has... stock shall have the right under this section to demand payment of the stock's fair or appraised value...

  8. 12 CFR 552.14 - Dissenter and appraisal rights.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... demand payment of fair or appraised value. Except as provided in paragraph (b) of this section, any... right to demand payment of the fair or appraised value of his stock: Provided, That such stockholder has... stock shall have the right under this section to demand payment of the stock's fair or appraised value...

  9. A Third-Party E-payment Protocol Based on Quantum Multi-proxy Blind Signature

    NASA Astrophysics Data System (ADS)

    Niu, Xu-Feng; Zhang, Jian-Zhong; Xie, Shu-Cui; Chen, Bu-Qing

    2018-05-01

    A third-party E-payment protocol is presented in this paper. It is based on quantum multi-proxy blind signature. Adopting the techniques of quantum key distribution, one-time pad and quantum multi-proxy blind signature, our third-party E-payment system could protect user's anonymity as the traditional E-payment systems do, and also have unconditional security which the classical E-payment systems can not provide. Furthermore, compared with the existing quantum E-payment systems, the proposed system could support the E-payment which using the third-party platforms.

  10. The Impact of New Payment Models on Quality of Diabetes Care and Outcomes.

    PubMed

    McGinley, Erin L; Gabbay, Robert A

    2016-06-01

    Historic changes in healthcare reimbursement and payment models due to the Affordable Care Act in the United States have the potential to transform how providers care for chronic diseases such as diabetes. Payment experimentation has provided insights into how changing incentives for primary care providers can yield improvements in the triple aim: improving patient experience, improving the health of populations, and reducing costs of healthcare. Much of this has involved leveraging widespread adoption of the patient-centered medical home (PCMH) with diabetes often the focus. While evidence is mounting that the PCMH can improve diabetes outcomes, some PCMH demonstrations have displayed mixed results. One of the first large-scale PCMH demonstrations developed around diabetes was conducted by the Commonwealth of Pennsylvania. Different payment models were employed across a series of staggered regional rollouts that provided a case study for the influence of innovative payment models. These learning laboratories provide insights into the role of reimbursement models and changes in how practice transformation is implemented. Ultimately, evolving payment systems focused on the total cost of care, such as Accountable Care Organizations, hold promise to transform diabetes care and produce significant cost savings through the prevention of complications.

  11. Ethical Implications of Case-Based Payment in China: A Systematic Analysis.

    PubMed

    Jin, Pingyue; Biller-Andorno, Nikola; Wild, Verina

    2015-12-01

    How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee-for-service to case-based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case-based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case-based payment. Some ethical problems of case-based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high-income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient-physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case-based payment is currently more ethically acceptable than fee-for-service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case-based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. © 2014 John Wiley & Sons Ltd.

  12. Paying substance abusers in research studies: where does the money go?

    PubMed

    Festinger, David S; Dugosh, Karen Leggett

    2012-01-01

    Research involving substance-abusing participants is often hindered by low rates of recruitment and retention. Research suggests that monetary payment or remuneration can be an effective strategy to overcome these obstacles. This article provides a brief overview of these issues and provides data reflecting how substance-abusing participants in several of our studies used their baseline and follow-up payments. We also present research findings related to how the mode of payment (i.e., cash, check, gift card) may affect how payments are used. Overall, our findings suggest that participants use their research payments in a responsible and safe manner. Limitations and recommendations for future research are discussed.

  13. Fee-for-service payment - an evil practice that must be stamped out?

    PubMed

    Ikegami, Naoki

    2015-02-01

    Co-opting physicians to regulate Fee-for-Service (FFS) payment is more feasible and simpler to administer than capitation, Diagnosis-Related Groups (DRGs) and pay-for-performance. The key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing. Adherence to these regulations must be strictly audited in order to control volume and costs, and to assure quality. The fee schedule requires periodic revisions on an item-by-item basis in order to maintain balance among the providers, to list new drugs, devices and equipment, and to reflect the lower market prices of existing ones. Implementing the fee schedule will facilitate the control of balance billing and extra billing, and the introduction of more sophisticated methods of payment in the future.

  14. HIT or miss: the application of health care information technology to managing uncertainty in clinical decision making.

    PubMed

    Kazandjian, Vahé A; Lipitz-Snyderman, Allison

    2011-12-01

    To discuss the usefulness of health care information technology (HIT) in assisting care providers minimize uncertainty while simultaneously increasing efficiency of the care provided. An ongoing study of HIT, performance measurement (clinical and production efficiency) and their implications to the payment for care represents the design of this study. Since 2006, all Maryland hospitals have embarked on a multi-faceted study of performance measures and HIT adoption surveys, which will shape the health care payment model in Maryland, the last of the all-payor states, in 2011. This paper focuses on the HIT component of the Maryland care payment initiative. While the payment model is still under review and discussion, 'appropriateness' of care has been discussed as an important dimension of measurement. Within this dimension, the 'uncertainty' concept has been identified as associated with variation in care practices. Hence, the methods of this paper define how HIT can assist care providers in addressing the concept of uncertainty, and then provides findings from the first HIT survey in Maryland to infer the readiness of Maryland hospital in addressing uncertainty of care in part through the use of HIT. Maryland hospitals show noteworthy variation in their adoption and use of HIT. While computerized, electronic patient records are not commonly used among and across Maryland hospitals, many of the uses of HIT internally in each hospital could significantly assist in better communication about better practices to minimize uncertainty of care and enhance the efficiency of its production. © 2010 Blackwell Publishing Ltd.

  15. 25 CFR 143.5 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... AFFAIRS, DEPARTMENT OF THE INTERIOR FINANCIAL ACTIVITIES CHARGES FOR GOODS AND SERVICES PROVIDED TO NON... billing date. (c) Upon non-payment by the non-Federal user, the Assistant Secretary may discontinue... to challenge payment or excuse non-payment within 14 days of the date on the notification letter. (2...

  16. 31 CFR 256.11 - How do agencies request payments?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... forms or by using other approved methods as provided for on the Judgment Fund Web site at http://www.fms..., Volume I, Part 6, Chapter 3100. The TFM is also available on the Judgment Fund Web site. The submitting...

  17. Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea.

    PubMed

    Lee, Kwangsoo; Lee, Sangil

    2007-05-01

    This study explored the effects of the diagnosis-related group (DRG)-based prospective payment system (PPS) operated by voluntarily participating organizations on the cesarean section (CS) rates, and analyzed whether the participating health care organizations had similar CS rates despite the varied participation periods. The study sample included delivery claims data from the Korean national health insurance program for the year 2003. Risk factors were identified and used in the adjustment model to distinguish the main reason for CS. Their risk-adjusted CS rates were compared by the reimbursement methods, and the organizations' internal and external environments were controlled. The final risk-adjustment model for the CS rates meets the criteria for an effective model. There were no significant differences of CS rates between providers in the DRG and fee-for-service system after controlling for organizational variables. The CS rates did not vary significantly depending on the providers' DRG participation periods. The results provide evidence that the DRG payment system operated by volunteering health care organizations had no impact on the CS rates, which can lower the quality of care. Although the providers joined the DRG system in different years, there were no differences in the CS rates among the DRG providers. These results support the future expansion of the DRG-based PPS plan to all health care services in Korea.

  18. How do patient characteristics influence informal payments for inpatient and outpatient health care in Albania: Results of logit and OLS models using Albanian LSMS 2005

    PubMed Central

    2011-01-01

    Background Informal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. By using data from the Living Standard Measurement Survey 2005 we control for individual determinants of informal payments in inpatient and outpatient health care. We use these results to explain the main factors contributing to the occurrence and extent of informal payments in Albania. Methods Using multivariate methods (logit and OLS) we test three models to explain informal payments: the cultural, economic and governance model. The results of logit models are presented here as odds ratios (OR) and results from OLS models as regression coefficients (RC). Results Our findings suggest differences in determinants of informal payments in inpatient and outpatient care. Generally our results show that informal payments are dependent on certain characteristics of patients, including age, area of residence, education, health status and health insurance. However, they are less dependent on income, suggesting homogeneity of payments across income categories. Conclusions We have found more evidence for the validity of governance and economic models than for the cultural model. PMID:21605459

  19. Prometheus payment model: application to hip and knee replacement surgery.

    PubMed

    Rastogi, Amita; Mohr, Beth A; Williams, Jeffery O; Soobader, Mah-Jabeen; de Brantes, Francois

    2009-10-01

    The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs. Of the 2076 commercially insured patients undergoing hip arthroplasty in our study, PAC costs totaled $7.8 million (14% of total costs; n = 699 index PAC stays). Similarly, PAC costs were $12.7 million (14% of total costs; n = 897 index PAC stays) for 3403 patients undergoing knee arthroplasty. By holding the providers clinically and financially responsible for PACs, and by segmenting and quantifying the type of PACs generated during and after the procedure, the Prometheus model creates an opportunity for providers to focus on the reduction of PACs, including readmissions, making the data actionable and turn the waste related to PAC costs into potential savings.

  20. 7 CFR 1435.503 - In-kind payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... (PIK) Program § 1435.503 In-kind payments. (a) CCC will, through such methods as CCC deems appropriate, make payments in the form of sugar held in CCC inventory. (b) To the maximum extent practicable, CCC will use its inventory in making an in-kind payment based on the following priority: (1) CCC-owned...

  1. 7 CFR 1435.503 - In-kind payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... (PIK) Program § 1435.503 In-kind payments. (a) CCC will, through such methods as CCC deems appropriate, make payments in the form of sugar held in CCC inventory. (b) To the maximum extent practicable, CCC will use its inventory in making an in-kind payment based on the following priority: (1) CCC-owned...

  2. 7 CFR 1435.503 - In-kind payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (PIK) Program § 1435.503 In-kind payments. (a) CCC will, through such methods as CCC deems appropriate, make payments in the form of sugar held in CCC inventory. (b) To the maximum extent practicable, CCC will use its inventory in making an in-kind payment based on the following priority: (1) CCC-owned...

  3. 7 CFR 1435.503 - In-kind payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... (PIK) Program § 1435.503 In-kind payments. (a) CCC will, through such methods as CCC deems appropriate, make payments in the form of sugar held in CCC inventory. (b) To the maximum extent practicable, CCC will use its inventory in making an in-kind payment based on the following priority: (1) CCC-owned...

  4. Evaluating community health centers’ adoption of a new global capitation payment (eCHANGE) study protocol

    PubMed Central

    Angier, H; O’Malley, JP; Marino, M; McConnell, KJ; Cottrell, E; Jacob, RL; Likumahuwa-Ackman, S; Heintzman, J; Huguet, N; Bailey, SR; DeVoe, JE

    2017-01-01

    Primary care patient-centered medical homes (PCMHs) are an effective healthcare delivery model. Evidence regarding the most effective payment models for increased coordination efforts is sparse. This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The APM is a primary care payment reform intervention that changed Oregon’s Medicaid payment for several CHCs from fee-for-service reimbursement to a per-member-per-month capitated payment. We will implement a difference-in-difference analytic approach to evaluate pre-post APM changes between intervention and control groups, including: 1) clinic-level outcomes, 2) patient-level clinical outcomes, and 3) patient-level econometric outcomes. Findings from the project will be of national significance, as there is a need for evidence regarding how novel payment methods might enhance PCMH capabilities and support their capacity to produce better quality and outcomes. If this capitated payment method is proven effective, study findings will inform dissemination of similar APMs nationwide. PMID:27836506

  5. Evaluating community health centers' adoption of a new global capitation payment (eCHANGE) study protocol.

    PubMed

    Angier, H; O'Malley, J P; Marino, M; McConnell, K J; Cottrell, E; Jacob, R L; Likumahuwa-Ackman, S; Heintzman, J; Huguet, N; Bailey, S R; DeVoe, J E

    2017-01-01

    Primary care patient-centered medical homes (PCMHs) are an effective healthcare delivery model. Evidence regarding the most effective payment models for increased coordination efforts is sparse. This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The APM is a primary care payment reform intervention that changed Oregon's Medicaid payment for several CHCs from fee-for-service reimbursement to a per-member-per-month capitated payment. We will implement a difference-in-difference analytic approach to evaluate pre-post APM changes between intervention and control groups, including: 1) clinic-level outcomes, 2) patient-level clinical outcomes, and 3) patient-level econometric outcomes. Findings from the project will be of national significance, as there is a need for evidence regarding how novel payment methods might enhance PCMH capabilities and support their capacity to produce better quality and outcomes. If this capitated payment method is proven effective, study findings will inform dissemination of similar APMs nationwide. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Medicaid spending on contraceptive coverage and pregnancy-related care

    PubMed Central

    2014-01-01

    Objective Up to 50% of pregnancies are unintended in the United States, and the healthcare costs associated with pregnancy are the most expensive among hospitalized conditions. The current study aims to assess Medicaid spending on various methods of contraception and on pregnancy care including unintended pregnancies. Methods We analyzed Medicaid health claims data from 2004 to 2010. Women 14–49 years of age initiating contraceptive methods and pregnant women were included as separate cohorts. Medicaid spending was summarized using mean all-cause and contraceptive healthcare payments per patient per month (PPPM) over a follow-up period of up to 12 months. Medicaid payments were also estimated in 2008 per female member of childbearing age per month (PFCPM) and per member per month (PMPM). Medicaid payments on unintended pregnancies were also evaluated PFCPM and PMPM in 2008. Results For short-acting reversible contraception (SARC) users, all-cause payments and contraceptive payments PPPM were respectively $365 and $18.3 for oral contraceptive (OC) users, $308 and $19.9 for transdermal users, $215 and $21.6 for vaginal ring users, and $410 and $8.8 for injectable users. For long-acting reversible contraception (LARC) users (follow-up of 9–10 months), corresponding payments were $194 and $36.8 for IUD users, and $237 and $29.9 for implant users. Pregnancy cohort all-cause mean healthcare payments PPPM were $610. Payments PFCPM and PMPM for contraceptives were $1.44 and $0.54, while corresponding costs of pregnancies were estimated at $39.91 and $14.81, respectively. Payments PFCPM and PMPM for contraceptives represented a small fraction at 6.56% ($1.44/$21.95) and 6.63% ($0.54/$8.15), respectively of the estimated payments for unintended pregnancy. Conclusions This study of a large sample of Medicaid beneficiaries demonstrated that, over a follow-up period of 12 months, Medicaid payments for pregnancy were considerably higher than payments for either SARC or LARC users. Healthcare payments for contraceptives represented a small proportion of payments for unintended pregnancy when considering the overall Medicaid population perspective in 2008. PMID:24581033

  7. 42 CFR 422.208 - Physician incentive plans: requirements and limitations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... difference between the maximum potential payments and the minimum potential payments is more than 25 percent... have the effect of reducing or limiting the services provided to any plan enrollee. Potential payments... considered in this determination. (2) Risk threshold. The risk threshold is 25 percent of potential payments...

  8. 42 CFR 422.208 - Physician incentive plans: requirements and limitations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... difference between the maximum potential payments and the minimum potential payments is more than 25 percent... have the effect of reducing or limiting the services provided to any plan enrollee. Potential payments... considered in this determination. (2) Risk threshold. The risk threshold is 25 percent of potential payments...

  9. 42 CFR 422.208 - Physician incentive plans: requirements and limitations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... difference between the maximum potential payments and the minimum potential payments is more than 25 percent... have the effect of reducing or limiting the services provided to any plan enrollee. Potential payments... considered in this determination. (2) Risk threshold. The risk threshold is 25 percent of potential payments...

  10. 42 CFR 493.1809 - Limitation on Medicaid payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Limitation on Medicaid payment. 493.1809 Section 493.1809 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Limitation on Medicaid payment. As provided in section 1902(a)(9)(C) of the Act, payment for laboratory...

  11. 14 CFR 151.61 - Grant payments: Partial.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... payments: Partial. (a) Subject to the final determination of allowable project costs as provided in § 151.63 partial grant payments for project costs may be made to a sponsor upon application. Unless... partial payments to the estimated United States share of the project costs of the airport development...

  12. 14 CFR 151.61 - Grant payments: Partial.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... payments: Partial. (a) Subject to the final determination of allowable project costs as provided in § 151.63 partial grant payments for project costs may be made to a sponsor upon application. Unless... partial payments to the estimated United States share of the project costs of the airport development...

  13. 14 CFR 151.61 - Grant payments: Partial.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... payments: Partial. (a) Subject to the final determination of allowable project costs as provided in § 151.63 partial grant payments for project costs may be made to a sponsor upon application. Unless... partial payments to the estimated United States share of the project costs of the airport development...

  14. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-06

    ... Hospital IPPS Inpatient prospective payment system MS-DRG Diagnosis-related group NCA National coverage... based on the ``inpatient prospective payment system'' (IPPS) described in section 1886(d) of the Act... and procedures, and payment systems. We reviewed various articles, reports, summaries, and data bases...

  15. 42 CFR 431.960 - Types of payment errors.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.960 Types of payment errors. (a) General rule. State or provider errors identified for the Medicaid and CHIP improper payments measurement under the... been paid by a third party but were inappropriately paid by Medicaid or CHIP. (v) Pricing errors. (vi...

  16. 42 CFR 431.960 - Types of payment errors.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.960 Types of payment errors. (a) General rule. State or provider errors identified for the Medicaid and CHIP improper payments measurement under the... been paid by a third party but were inappropriately paid by Medicaid or CHIP. (v) Pricing errors. (vi...

  17. 42 CFR 431.960 - Types of payment errors.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.960 Types of payment errors. (a) General rule. State or provider errors identified for the Medicaid and CHIP improper payments measurement under the... been paid by a third party but were inappropriately paid by Medicaid or CHIP. (v) Pricing errors. (vi...

  18. 42 CFR 431.960 - Types of payment errors.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.960 Types of payment errors. (a) General rule. State or provider errors identified for the Medicaid and CHIP improper payments measurement under the... been paid by a third party but were inappropriately paid by Medicaid or CHIP. (v) Pricing errors. (vi...

  19. 20 CFR 416.2098 - Supplementary payment levels.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Supplementary payment levels. 416.2098... Supplementary payment levels. (a) General. For the purpose of determining the combined supplementary/SSI payment levels described in § 416.2097(a) (i.e., the levels that must be provided in any month after March 1983...

  20. 5 CFR 1315.13 - Commodity Credit Corporation payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Commodity Credit Corporation payments. 1315.13 Section 1315.13 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.13 Commodity Credit Corporation payments. As provided in § 1315.1(d), the provisions of...

  1. 40 CFR 35.938-6 - Progress payments to contractors.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Progress payments to contractors. 35... § 35.938-6 Progress payments to contractors. (a) Policy. EPA policy is that, except as State law otherwise provides, grantees should make prompt progress payments to prime contractors and prime contractors...

  2. 20 CFR 30.709 - How are payments for medicinal drugs determined?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How are payments for medicinal drugs... for Medical Providers Medical Fee Schedule § 30.709 How are payments for medicinal drugs determined? Payment for medicinal drugs prescribed by physicians shall not exceed the amount derived by multiplying...

  3. 75 FR 9141 - Reduced 2009 Estimated Income Tax Payments for Individuals With Small Business Income

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-01

    ... Reduced 2009 Estimated Income Tax Payments for Individuals With Small Business Income AGENCY: Internal... their required 2009 estimated income tax payments. The temporary regulations implement section 1212 of... Revenue Code (Code) to provide for reduced 2009 estimated income tax payments for certain qualified...

  4. Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement

    PubMed Central

    Whitcomb, Winthrop F.; Lagu, Tara; Krushell, Robert J.; Lehman, Andrew P.; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S.; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K.

    2015-01-01

    Background Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Methods Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. Results The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls— patients treated before bundle implementation—45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p = .24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p = .43), and lower median posthospital payments ($704 versus $1,121, p = .002), and were more likely to receive guideline-consistent care (99% versus 95%, p = .05). Discussion The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams. PMID:26289235

  5. Design and implementation of Bluetooth beacon in mobile payment system

    NASA Astrophysics Data System (ADS)

    Han, Tiantian; Ding, Lei

    2017-08-01

    The current line of payment means, mainly in the following ways, cash payment, credit card payment, WeChat Alipay sweep payment. There are many inconvenience in Cash payment, large amounts of cash inconvenience to carry, count the money to spend time and effort, true and false banknotes difficult to distinguish, ticket settlement easy to go wrong. Credit card payment is relatively time-consuming, and WeChat Alipay sweep payment need to sweep. Therefore, the design of a convenient, fast payment to meet the line to pay the demand is particularly important. Based on the characteristics of BLE Bluetooth wireless communication technology, this paper designs a kind of payment method based on Bluetooth beacon. Through the Bluetooth beacon broadcast consumption, consumers only need to open the relevant APP in the Android client, and you can get Bluetooth via mobile phone Bluetooth the amount of consumption of the standard broadcast, in accordance with the corresponding payment platform to complete the payment process, which pay less time to improve the efficiency of payment.

  6. Allocating Practice Expense Under the Medicare Fee Schedule

    PubMed Central

    Pope, Gregory C.; Burge, Russel T.

    1993-01-01

    Currently, relative value units for practice expense are determined under the Medicare fee schedule (MFS) using historical physician charges. This seems inconsistent with the goal of a resource-based fee schedule. A specialty resource-based method of determining practice expense payments is presented and simulated here. The method assumes that, for each service, the payment for practice expense should be the same proportion of the total payment as actual physician practice expenses are of total practice revenues. A comparison with the approach developed by the Physician Payment Review Commission (PPRC) shows similar fees, but the specialty-based method proposed here requires no data beyond what is already employed in the MFS. PMID:10130574

  7. An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas

    ERIC Educational Resources Information Center

    Chan, Leighton; Hart, L. Gary; Ricketts III, Thomas C.; Beaver, Shelli K.

    2004-01-01

    Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians. Purpose: To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's…

  8. 42 CFR 412.532 - Special payment provisions for patients who are transferred to onsite providers and readmitted to...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... percent) of the total number of its Medicare inpatients discharged from that acute care hospital, all such... transferred to onsite providers and readmitted to a long-term care hospital. 412.532 Section 412.532 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...

  9. Application of total care time and payment per unit time model for physician reimbursement for common general surgery operations.

    PubMed

    Chatterjee, Abhishek; Holubar, Stefan D; Figy, Sean; Chen, Lilian; Montagne, Shirley A; Rosen, Joseph M; Desimone, Joseph P

    2012-06-01

    The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement. Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time. Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was $455.73 and slightly more at $467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time ($188.52). Laparoscopic gastric bypass had the highest payment per time ($707.30). The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Information on Receiving Contract and Commercial Payments

    EPA Pesticide Factsheets

    Provides links to payment instructions and financial forms and reports for vendors and grant recipients. Billing tips, instructions for submitting invoices electronically or by email, including submitting simplified acquisition payments (SAPs).

  11. Medicare program; prospective payment system for hospital outpatient services--HCFA. Proposed rule.

    PubMed

    1998-09-08

    As required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, this proposed rule would eliminate the formula-driven overpayment for certain outpatient hospital services, extend reductions in payment for costs of hospital outpatient services, and establish in regulations a prospective payment system for hospital outpatient services (and for Medicare Part B services furnished to inpatients who have no Part A coverage). The prospective payment system would simplify our current payment system and apply to all hospitals, including those that are excluded from the inpatient prospective payment system. The Balanced Budget Act provides for implementation of the prospective payment system effective January 1, 1999, but delays application of the system to cancer hospitals until January 1, 2000. The hospital outpatient prospective payment system would also apply to partial hospitalization services furnished by community mental health centers. Although the statutory effective date for the outpatient prospective payment system is January 1, 1999, implementation of the new system will have to be delayed because of year 2000 systems concerns. The demands on intermediary bill processing systems and HCFA internal systems to become compliant for the year 2000 preclude making the major systems changes that are required to implement the prospective payment system. The outpatient prospective payment system will be implemented for all hospitals and community mental health centers as soon as possible after January 1, 2000, and a notice of the anticipated implementation date will be published in the Federal Register at least 90 days in advance. This document also proposes new requirements for provider departments and provider-based entities. These proposed changes, as revised based on our consideration of public comments, will be effective 30 days after publication of a final rule. This proposed rule would also implement section 9343(c) of the Omnibus Budget Reconciliation Act of 1986, which prohibits Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital, unless the services are furnished under an arrangement with the hospital. This section also authorizes the Department of Health and Human Services' Office of Inspector General to impose a civil money penalty, not to exceed $10,000, against any individual or entity who knowingly and willfully presents a bill for nonphysician or other bundled services not provided directly or under such an arrangement. This proposed rule also addresses the requirements for designating certain entities as provider-based or as a department of a hospital.

  12. 20 CFR 435.22 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH... electronic funds transfers are not used. (f) Working capital advance method. If a recipient cannot meet the... recipient lacks sufficient working capital, SSA may provide cash on a working capital advance basis. Under...

  13. 20 CFR 435.22 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH... electronic funds transfers are not used. (f) Working capital advance method. If a recipient cannot meet the... recipient lacks sufficient working capital, SSA may provide cash on a working capital advance basis. Under...

  14. 20 CFR 411.575 - How does the EN request payment for milestones or outcome payment months achieved by a...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... outcome payment months achieved by a beneficiary who assigned a ticket to the EN? The EN (or State VR... provided as described in the IWP/IPE. (a) Milestone payments. (1) We will pay the EN (or State VR agency... VR agency's) elected payment system in effect at the time the beneficiary assigned a ticket to the EN...

  15. 20 CFR 411.575 - How does the EN request payment for milestones or outcome payment months achieved by a...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... outcome payment months achieved by a beneficiary who assigned a ticket to the EN? The EN (or State VR... provided as described in the IWP/IPE. (a) Milestone payments. (1) We will pay the EN (or State VR agency... VR agency's) elected payment system in effect at the time the beneficiary assigned a ticket to the EN...

  16. Paying Substance Abusers in Research Studies: Where Does the Money Go?

    PubMed Central

    Festinger, David S.; Dugosh, Karen L.

    2013-01-01

    Research involving substance abusing participants is often hindered by low rates of recruitment and retention. Research suggests that monetary payment or remuneration can be an effective strategy to overcome these obstacles. This paper provides a brief overview of these issues and provides data reflecting how substance abusing participants in several of our studies used their baseline and follow-up payments. We also present research findings related to how the mode of payment (i.e.., cash, check, gift card) may affect how payments are used. Overall, our findings suggest that participants use their research payments in a responsible and safe manner. Limitations and recommendations for future research are discussed. PMID:22185328

  17. 42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... establishes the method for determining Medicare payments for services related to covered ambulatory surgical... deductibles and coinsurance; or (2) The blended payment amount as described in paragraph (d) of this section...) Blended payment amount. (1) For cost reporting periods beginning on or after October 1, 1987 but before...

  18. Adjusting case mix payment amounts for inaccurately reported comorbidity data.

    PubMed

    Sutherland, Jason M; Hamm, Jeremy; Hatcher, Jeff

    2010-03-01

    Case mix methods such as diagnosis related groups have become a basis of payment for inpatient hospitalizations in many countries. Specifying cost weight values for case mix system payment has important consequences; recent evidence suggests case mix cost weight inaccuracies influence the supply of some hospital-based services. To begin to address the question of case mix cost weight accuracy, this paper is motivated by the objective of improving the accuracy of cost weight values due to inaccurate or incomplete comorbidity data. The methods are suitable to case mix methods that incorporate disease severity or comorbidity adjustments. The methods are based on the availability of detailed clinical and cost information linked at the patient level and leverage recent results from clinical data audits. A Bayesian framework is used to synthesize clinical data audit information regarding misclassification probabilities into cost weight value calculations. The models are implemented through Markov chain Monte Carlo methods. An example used to demonstrate the methods finds that inaccurate comorbidity data affects cost weight values by biasing cost weight values (and payments) downward. The implications for hospital payments are discussed and the generalizability of the approach is explored.

  19. 42 CFR 414.232 - Special payment rules for transcutaneous electrical nerve stimulators (TENS).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... nerve stimulators (TENS). 414.232 Section 414.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Special payment rules for transcutaneous electrical nerve stimulators (TENS). (a) General payment rule. Except as provided in paragraph (b) of this section, payment for TENS is made on a purchase basis with...

  20. 20 CFR 404.1928 - Effect of the alien non-payment provision.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Effect of the alien non-payment provision... the alien non-payment provision. An agreement may provide that a person entitled to benefits under... party to the agreement, regardless of the alien non-payment provision (see § 404.460). ...

  1. 20 CFR 404.1928 - Effect of the alien non-payment provision.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Effect of the alien non-payment provision... the alien non-payment provision. An agreement may provide that a person entitled to benefits under... party to the agreement, regardless of the alien non-payment provision (see § 404.460). ...

  2. 20 CFR 404.1928 - Effect of the alien non-payment provision.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Effect of the alien non-payment provision... the alien non-payment provision. An agreement may provide that a person entitled to benefits under... party to the agreement, regardless of the alien non-payment provision (see § 404.460). ...

  3. 20 CFR 404.1928 - Effect of the alien non-payment provision.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Effect of the alien non-payment provision... the alien non-payment provision. An agreement may provide that a person entitled to benefits under... party to the agreement, regardless of the alien non-payment provision (see § 404.460). ...

  4. 20 CFR 404.1928 - Effect of the alien non-payment provision.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Effect of the alien non-payment provision... the alien non-payment provision. An agreement may provide that a person entitled to benefits under... party to the agreement, regardless of the alien non-payment provision (see § 404.460). ...

  5. 7 CFR 765.405 - Payment of costs associated with transfers.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... transferee, with Agency approval, may pay these costs provided: (a) Any cash equity due the transferor is applied first to payment of costs and the transferor does not receive any cash payment above these costs... 7 Agriculture 7 2010-01-01 2010-01-01 false Payment of costs associated with transfers. 765.405...

  6. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Drugs and biologicals that are paid under a separate APC; and (2) Items and services paid at charges... excluded from qualification for the payment adjustment in paragraph (g)(2) of this section: (i) Drugs and...) Payment adjustment for certain cancer hospitals—(1) General rule. CMS provides for a payment adjustment...

  7. 42 CFR 403.815 - Special rules concerning States.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... payment of coinsurance. (1) A State may enter into payment arrangements with pharmacies to provide payment... pharmacy. (2) Expenditures made by a State for coinsurance described in paragraph (b)(1) of this section...

  8. 42 CFR 403.815 - Special rules concerning States.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... payment of coinsurance. (1) A State may enter into payment arrangements with pharmacies to provide payment... pharmacy. (2) Expenditures made by a State for coinsurance described in paragraph (b)(1) of this section...

  9. 42 CFR 403.815 - Special rules concerning States.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... payment of coinsurance. (1) A State may enter into payment arrangements with pharmacies to provide payment... pharmacy. (2) Expenditures made by a State for coinsurance described in paragraph (b)(1) of this section...

  10. 42 CFR 403.815 - Special rules concerning States.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... payment of coinsurance. (1) A State may enter into payment arrangements with pharmacies to provide payment... pharmacy. (2) Expenditures made by a State for coinsurance described in paragraph (b)(1) of this section...

  11. Medicare Program; Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model: Extreme and Uncontrollable Circumstances Policy for the Comprehensive Care for Joint Replacement Payment Model. Final rule; interim final rule with comment period.

    PubMed

    2017-12-01

    This final rule cancels the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model, including: Giving certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model; technical refinements and clarifications for certain payment, reconciliation and quality provisions; and a change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (Advanced APM) track. An interim final rule with comment period is being issued in conjunction with this final rule in order to address the need for a policy to provide some flexibility in the determination of episode costs for providers located in areas impacted by extreme and uncontrollable circumstances.

  12. Medicare payment reform and provider entry and exit in the post-acute care market.

    PubMed

    Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

    2013-10-01

    To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. © Health Research and Educational Trust.

  13. 77 FR 15605 - Mobile Commerce and Personalization Promotion

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-16

    ... automation mailings. Postage Payment Methods Postage payment methods will be restricted to permit imprint.... 2. Standard Mail (including Nonprofit) letters or flats. d. Postage must be paid by permit imprint...

  14. Annuity payments can increase patient access to innovative cell and gene therapies under England’s net budget impact test

    PubMed Central

    Jørgensen, Jesper; Kefalas, Panos

    2017-01-01

    ABSTRACT Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results: Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test. PMID:28839525

  15. 7 CFR 301.75-16 - Payments for the recovery of lost production income.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... following the destruction of the insured trees, the payment provided for under paragraph (b)(1) of this... trees, the per-acre payment provided for under paragraph (b)(1) of this section will be reduced by 5... production that was lost as the result of the removal of commercial citrus trees to control citrus canker. (a...

  16. 7 CFR 301.75-16 - Payments for the recovery of lost production income.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... following the destruction of the insured trees, the payment provided for under paragraph (b)(1) of this... trees, the per-acre payment provided for under paragraph (b)(1) of this section will be reduced by 5... production that was lost as the result of the removal of commercial citrus trees to control citrus canker. (a...

  17. 7 CFR 301.75-16 - Payments for the recovery of lost production income.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... following the destruction of the insured trees, the payment provided for under paragraph (b)(1) of this... trees, the per-acre payment provided for under paragraph (b)(1) of this section will be reduced by 5... production that was lost as the result of the removal of commercial citrus trees to control citrus canker. (a...

  18. 7 CFR 301.75-16 - Payments for the recovery of lost production income.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... following the destruction of the insured trees, the payment provided for under paragraph (b)(1) of this... trees, the per-acre payment provided for under paragraph (b)(1) of this section will be reduced by 5... production that was lost as the result of the removal of commercial citrus trees to control citrus canker. (a...

  19. Medicare’s Payment Strategy For End-Stage Renal Disease Now Embraces Bundled Payment And Pay-For-Performance To Cut Costs

    PubMed Central

    Swaminathan, Shailender; Mor, Vincent; Mehrotra, Rajnish; Trivedi, Amal

    2013-01-01

    Since 1973 Medicare has provided health insurance coverage to all people who have been diagnosed with end-stage renal disease, or kidney failure. In this article we trace the history of payment policies in Medicare’s dialysis program from 1973 to 2011, while also providing some insight into the rationale for changes made over time. Initially, Medicare adopted a fee-for-service payment policy for dialysis care, using the same reimbursement standards employed in the broader Medicare program. However, driven by rapid spending growth in this population, the dialysis program has implemented innovative payment reforms, such as prospective bundled payments and pay-for-performance incentives. It is uncertain whether these strategies can stem the increase in the total cost of dialysis to Medicare, or whether they can do so without adversely affecting the quality of care. Future research on the intended and unintended consequences of payment reform will be critical. PMID:22949455

  20. Medicare payment transparency

    PubMed Central

    Jones, Lyell K.; Craft, Karolina; Fritz, Joseph V.

    2016-01-01

    Abstract In 2014, the Centers for Medicare and Medicaid Services began a now annual process of releasing payment data made to physicians and other providers from Medicare Part B. The unprecedented availability of detailed payment information has generated considerable interest among policymakers, the public, and the media, and raised concerns from a number of physician groups. In the current climate of financial transparency, publication of Medicare payment data will likely continue. In an effort to prepare neurologists for future releases of payment data, we review the background, limitations, potential benefits, and appropriate responses to Medicare payment data releases. PMID:29443257

  1. Pay-per-view in interlibrary loan: a case study

    PubMed Central

    Brown, Heather L

    2012-01-01

    Question: Can purchasing articles from publishers be a cost-effective method of interlibrary loan (ILL) for libraries owing significant copyright royalties? Setting: The University of Nebraska Medical Center's McGoogan Library of Medicine provides the case study. Method: Completed ILL requests that required copyright payment were identified for the first quarter of 2009. The cost of purchasing these articles from publishers was obtained from the publishers' websites and compared to the full ILL cost. A pilot period of purchasing articles from the publisher was then conducted. Results: The first-quarter sample data showed that approximately $500.00 could have been saved if the articles were purchased from the publisher. The pilot period and continued purchasing practice have resulted in significant savings for the library. Conclusion: Purchasing articles directly from the publisher is a cost-effective method for libraries burdened with high copyright royalty payments. PMID:22514505

  2. 7 CFR 3015.102 - Payment methods.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Payment methods. 3015.102 Section 3015.102... methods. (a) Non-construction. (1) Letters of credit will be used to pay USDA recipients when all the... (iii) of this section. (3) Reimbursement by Treasury check shall be the preferred method when the...

  3. 7 CFR 3015.102 - Payment methods.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Payment methods. 3015.102 Section 3015.102... methods. (a) Non-construction. (1) Letters of credit will be used to pay USDA recipients when all the... (iii) of this section. (3) Reimbursement by Treasury check shall be the preferred method when the...

  4. 7 CFR 3015.102 - Payment methods.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Payment methods. 3015.102 Section 3015.102... methods. (a) Non-construction. (1) Letters of credit will be used to pay USDA recipients when all the... (iii) of this section. (3) Reimbursement by Treasury check shall be the preferred method when the...

  5. 7 CFR 3015.102 - Payment methods.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Payment methods. 3015.102 Section 3015.102... methods. (a) Non-construction. (1) Letters of credit will be used to pay USDA recipients when all the... (iii) of this section. (3) Reimbursement by Treasury check shall be the preferred method when the...

  6. 7 CFR 3015.102 - Payment methods.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Payment methods. 3015.102 Section 3015.102... methods. (a) Non-construction. (1) Letters of credit will be used to pay USDA recipients when all the... (iii) of this section. (3) Reimbursement by Treasury check shall be the preferred method when the...

  7. Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

    PubMed

    Mead, Holly; Grantham, Sarah; Siegel, Bruce

    2014-01-01

    Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

  8. Decomposition of the drivers of the U.S. hospital spending growth, 2001–2009

    PubMed Central

    2014-01-01

    Background United States health care spending rose rapidly in the 2000s, after a period of temporary slowdown in the 1990s. However, the description of the overall trend and the understanding of the underlying drivers of this trend are very limited. This study investigates how well historical hospital cost/revenue drivers explain the recent hospital spending trend in the 2000s, and how important each of these drivers is. Methods We used aggregated time series data to describe the trend in total hospital spending, price, and quantity between 2001 and 2009. We used the Oaxaca-Blinder method to investigate the relative importance of major hospital cost/spending drivers (derived from the literature) in explaining the change in hospital spending patterns between 2001 and 2007. We assembled data from Medicare Cost Reports, American Hospital Association annual surveys, Prospective Payment System (PPS) Impact Files, Medicare Provider Analysis and Review (MedPAR) Medicare claims data, InterStudy reports, National Health Expenditure data, and Area Resource Files. Results Aggregated time series trends show that high hospital spending between 2001 and 2009 appears to be driven by higher payment per unit of hospital output, not by increased utilization. Results using the Oaxaca-Blinder regression decomposition method indicate that changes in historically important spending drivers explain a limited 30% of unit-payment growth, but a higher 60% of utilization growth. Hospital staffing and labor-related costs, casemix, and demographics are the most important drivers of higher hospital revenue, utilization, and unit-payment. Technology is associated with lower utilization, higher unit payment, and limited increases in total revenue. Market competition, primarily because of increased managed care concentration, moderates total revenue growth by driving lower unit payment. Conclusions Much of the rapidly rising hospital spending growth in the 2000s in the United States is driven by factors not commonly known or well measured. Future studies need to explore new factors and dynamics that drive longer-term hospital spending growth in recent years, particularly through the channel of higher prices. PMID:24886580

  9. Equity in Medicaid Reimbursement for Otolaryngologists.

    PubMed

    Conduff, Joseph H; Coelho, Daniel H

    2017-12-01

    Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC. The difference in Medicaid and Medicare payment in dollars and percentage was determined and the reimbursement per relative value unit calculated. Medicaid reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the Medicare benchmark. Results Marked differences in Medicaid and Medicare reimbursement exist for all services provided by otolaryngologists, most commonly as a substantial shortfall. The Medicaid shortfall varied in amount among states, and great variability in reimbursement exists within and between operative and outpatient services. Operative services were more likely than outpatient services to have a greater Medicaid shortfall. Shortfalls and excesses were not consistent among procedures or states. Conclusions The variation in Medicaid payment models reflects marked differences in the value of the same work provided by otolaryngologists-in many cases, far less than federal benchmarks. These results question the fairness of the Medicaid reimbursement scheme in otolaryngology, with potential serious implications on access to care for this underserved patient population.

  10. 76 FR 71934 - Tobacco Transition Payment Program; Availability of Current Assessment Methods Determination...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ... DEPARTMENT OF AGRICULTURE Farm Service Agency Tobacco Transition Payment Program; Availability of Current Assessment Methods Determination Document AGENCY: Commodity Credit Corporation and Farm Service... current methods used to calculate manufacturer and importer assessments that fund the Tobacco Transition...

  11. 20 CFR 416.2214 - Services for which payment may be made.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

  12. 20 CFR 416.2214 - Services for which payment may be made.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

  13. 5 CFR 1315.13 - Commodity Credit Corporation payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Commodity Credit Corporation payments... PAYMENT § 1315.13 Commodity Credit Corporation payments. As provided in § 1315.1(d), the provisions of... Credit Corporation (CCC) pursuant to Section 4(h) of the Act of June 29, 1948 (15 U.S.C. 714b(h)) (“CCC...

  14. 5 CFR 1315.13 - Commodity Credit Corporation payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Commodity Credit Corporation payments... PAYMENT § 1315.13 Commodity Credit Corporation payments. As provided in § 1315.1(d), the provisions of... Credit Corporation (CCC) pursuant to Section 4(h) of the Act of June 29, 1948 (15 U.S.C. 714b(h)) (“CCC...

  15. 5 CFR 1315.13 - Commodity Credit Corporation payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Commodity Credit Corporation payments... PAYMENT § 1315.13 Commodity Credit Corporation payments. As provided in § 1315.1(d), the provisions of... Credit Corporation (CCC) pursuant to Section 4(h) of the Act of June 29, 1948 (15 U.S.C. 714b(h)) (“CCC...

  16. 5 CFR 1315.13 - Commodity Credit Corporation payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Commodity Credit Corporation payments... PAYMENT § 1315.13 Commodity Credit Corporation payments. As provided in § 1315.1(d), the provisions of... Credit Corporation (CCC) pursuant to Section 4(h) of the Act of June 29, 1948 (15 U.S.C. 714b(h)) (“CCC...

  17. 77 FR 76624 - Prompt Payment Interest Rate; Contract Disputes Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-28

    ... DEPARTMENT OF THE TREASURY Fiscal Service Prompt Payment Interest Rate; Contract Disputes Act... beginning January 1, 2013, and ending on June 30, 2013, the prompt payment interest rate is 1-3/8 per centum... Prompt Payment Act, 31 U.S.C. 3902(a), provide for the calculation of interest due on claims at the rate...

  18. 20 CFR 416.2214 - Services for which payment may be made.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

  19. 20 CFR 416.2214 - Services for which payment may be made.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

  20. 20 CFR 416.2214 - Services for which payment may be made.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

  1. 46 CFR 280.4 - Standards governing payment of ODS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Standards governing payment of ODS. 280.4 Section 280.4... Standards governing payment of ODS. (a) Full payment. Except to the extent otherwise provided in § 280.8, ODS shall be paid in full to the operator for vessel operations on the inbound and outbound legs of...

  2. 10 CFR 1004.9 - Fees for providing records.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... full payment where the requester has a history of prompt payment of FOIA fees, or require an advance payment of an amount up to the full estimated charges in the case of requesters with no history of payment. (ii) A requester has previously failed to pay a fee in a timely fashion (i.e., within 30 days of the...

  3. 42 CFR 419.43 - Adjustments to national program payment and beneficiary copayment amounts.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Drugs and biologicals that are paid under a separate APC; and (2) Items and services paid at charges... excluded from qualification for the payment adjustment in paragraph (g)(2) of this section: (i) Drugs and...) Payment adjustment for certain cancer hospitals.—(1) General rule. CMS provides for a payment adjustment...

  4. How to deal with burden of critical illness: A comparison of strategies in different areas of China.

    PubMed

    Liu, Pengcheng; Jiang, Liwen; Li, Chengyue; Sun, Mei; Rieger, Alexander; Hao, Mo

    2014-05-01

    This article aims to introduce, compare and analyze the design and development of Critical Illness Insurance systems in different parts of China under different social and economic conditions, to explain their characteristics and similarities. It may provide references to other countries, especially developing countries, to solve the problem of high medical costs. According to the methods in Comparative Economics, 3 areas (Taicang in Jiangsu, Zhanjiang in Guangdong, Xunyi in Shanxi) which are in high, medium and low socio-economic condition respectively were chosen in China. Their critical illness insurance systems were analyzed in the study. Each system shares several common points, including coordinating urban and rural medical insurance fund, financing from the basic medical insurance surplus, and exploring payment reform and so on. But in the way of management, Taicang and Zhanjiang cooperate with commercial insurance agencies, but Xunyi chooses autonomous management by government. In Xunyi, multi-channel financing is relatively more dispersed, while funds of Taicang and Zhanjiang are mainly from the basic medical insurance surplus. The specific method of payment is different among these three areas. Because of the differences in economic development, population structure, and sources of funds, each area took their own mode on health policy orientation, financing, payment, coverage, and fund management to design their Critical Illness Insurance systems. This might provide references to other areas in China and other developing countries in the world.

  5. 15 CFR 14.22 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NON-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods... transfer of funds and disbursement by the recipient, and financial management systems that meet the...

  6. Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.

    PubMed

    Berenson, Robert A; Rice, Thomas

    2015-12-01

    The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. Payment policy should help temper the current "more is better" attitude of physicians and provider organizations. Incentive neutrality would better support health professionals' intrinsic motivation to act in their patients' best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians' intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care. Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes. © Health Research and Educational Trust.

  7. 26 CFR 19.3-1 - Interest on certain deferred payments; interest rate for use in determining whether there is...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... annum simple interest shall be used. As an illustration of the meaning of simple interest, if a contract provides for payments of $6,000 in 3 equal installments of $2,000 plus 4 percent per annum simple interest... provides for discounting payments at a 4 percent per annum simple interest rate, shall be used for...

  8. Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care?

    PubMed

    Baji, Petra; Rubashkin, Nicholas; Szebik, Imre; Stoll, Kathrin; Vedam, Saraswathi

    2017-09-01

    In Central and Eastern Europe, many women make informal cash payments to ensure continuity of provider, i.e., to have a "chosen" doctor who provided their prenatal care, be present for birth. High rates of obstetric interventions and disrespectful maternity care are also common to the region. No previous study has examined the associations among informal payments, intervention rates, and quality of maternity care. We distributed an online cross-sectional survey in 2014 to a nationally representative sample of Hungarian internet-using women (N = 600) who had given birth in the last 5 years. The survey included items related to socio-demographics, type of provider, obstetric interventions, and experiences of care. Women reported if they paid informally, and how much. We built a two-part model, where a bivariate probit model was used to estimate conditional probabilities of women paying informally, and a GLM model to explore the amount of payments. We calculated marginal effects of the covariates (provider choice, interventions, respectful care). Many more women (79%) with a chosen doctor paid informally (191 euros on average) compared to 17% of women without a chosen doctor (86 euros). Based on regression analysis, the chosen doctor's presence at birth was the principal determinant of payment. Intervention and procedure rates were significantly higher for women with a chosen doctor versus without (cesareans 45% vs. 33%; inductions 32% vs. 19%; episiotomy 75% vs. 62%; epidural 13% vs. 5%), but had no direct effect on payments. Half of the sample (42% with a chosen doctor, 62% without) reported some form of disrespectful care, but this did not reduce payments. Despite reporting disrespect and higher rates of interventions, women rewarded the presence of a chosen doctor with informal payments. They may be unaware of evidence-based standards, and trust that their chosen doctor provided high quality maternity care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. 24 CFR 232.540 - Method of loan payment and amortization period.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Purchase and Installation of Fire Safety Equipment Eligible Security Instruments § 232.540 Method of loan... either 60, 120, or 180 monthly amortization payments. No fire safety loan shall have an amortization...

  10. 24 CFR 232.540 - Method of loan payment and amortization period.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Purchase and Installation of Fire Safety Equipment Eligible Security Instruments § 232.540 Method of loan... either 60, 120, or 180 monthly amortization payments. No fire safety loan shall have an amortization...

  11. 24 CFR 232.540 - Method of loan payment and amortization period.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Purchase and Installation of Fire Safety Equipment Eligible Security Instruments § 232.540 Method of loan... either 60, 120, or 180 monthly amortization payments. No fire safety loan shall have an amortization...

  12. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule.

    PubMed

    2015-11-13

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

  13. From politics to policy: a new payment approach in Medicare Advantage.

    PubMed

    Berenson, Robert A

    2008-01-01

    While the Medicare Advantage program's future remains contentious politically, the Medicare Payment Advisory Commission's (MedPAC's) recommended policy of financial neutrality at the local level between private plans and traditional Medicare ignores local market dynamics in important ways. An analysis correlating plan bids against traditional Medicare's local spending levels likely would provide an alternative method of setting benchmarks, by producing a blend of local and national rates. A result would be that the rural and lower-cost urban "floor counties" would have benchmarks below currently inflated levels but above what financial neutrality at the local level--MedPAC's approach--would produce.

  14. Benefits in cash or in kind? A community consultation on types of benefits in health research on the Kenyan Coast.

    PubMed

    Njue, Maureen; Molyneux, Sassy; Kombe, Francis; Mwalukore, Salim; Kamuya, Dorcas; Marsh, Vicki

    2015-01-01

    Providing benefits and payments to participants in health research, either in cash or in kind, is a common but ethically controversial practice. While much literature has concentrated on appropriate levels of benefits or payments, this paper focuses on less well explored ethical issues around the nature of study benefits, drawing on views of community members living close to an international health research centre in Kenya. The consultation, including 90 residents purposively chosen to reflect diversity, used a two-stage deliberative process. Five half-day workshops were each followed by between two and four small group discussions, within a two week period (total 16 groups). During workshops and small groups, facilitators used participatory methods to share information, and promote reflection and debate on ethical issues around types of benefits, including cash, goods, medical and community benefits. Data from workshop and field notes, and voice recordings of small group discussions, were managed using Nvivo 10 and analysed using a Framework Analysis approach. The methods generated in-depth discussion with high levels of engagement. Particularly for the most-poor, under-compensation of time in research carries risks of serious harm. Cash payments may best support compensation of costs experienced; while highly valued, goods and medical benefits may be more appropriate as an 'appreciation' or incentive for participation. Community benefits were seen as important in supporting but not replacing individual-level benefits, and in building trust in researcher-community relations. Cash payments were seen to have higher risks of undue inducement, commercialising relationships and generating family conflicts than other benefits, particularly where payments are high. Researchers should consider and account for burdens families may experience when children are involved in research. Careful context-specific research planning and skilled and consistent communication about study benefits and payments are important, including in mitigating potential negative effects.

  15. Implementation of DRG Payment in France: issues and recent developments.

    PubMed

    Or, Zeynep

    2014-08-01

    In France, a DRG-based payment system was introduced in 2004/2005 for funding acute services in all hospitals with the objectives of improving hospital efficiency, transparency and fairness in payments to public and private hospitals. Despite the initial consensus on the necessity of the reform, providers have become increasingly critical of the system because of the problems encountered during the implementation. In 2012 the government announced its intention to modify the payment model to better deal with its adverse effects. The paper reports on the issues raised by the DRG-based payment in the French hospital sector and provides an overview of the main problems with the French DRG payment model. It also summarises the evidence on its impact and presents recent developments for reforming the current model. DRG-based payment addressed some of the chronic problems inherent in the French hospital market and improved accountability and productivity of health-care facilities. However, it has also created new problems for controlling hospital activity and ensuring that care provided is medically appropriate. In order to alter its adverse effects the French DRG model needs to better align greater efficiency with the objectives of better quality and effectiveness of care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. 42 CFR 413.149 - Depreciation: Allowance for depreciation on assets financed with Federal or public funds.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR... function of payment of depreciation to provide funds that make it possible to maintain the assets and...

  17. Wage Payment Systems. Supervising: Economic and Financial Aspects. The Choice Series #73. A Self Learning Opportunity.

    ERIC Educational Resources Information Center

    Carlisle, Ysanne

    This student guide is intended to assist persons employed as supervisors in understanding various wage payment systems. Discussed in the first four sections are the following topics: the aims and determination of payment (aims of a payment system, the economy and wage levels, the government and wage levels, and method of pay and wage levels); main…

  18. 7 CFR 550.22 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... GENERAL ADMINISTRATIVE POLICY FOR NON-ASSISTANCE COOPERATIVE AGREEMENTS Management of Agreements Financial Management § 550.22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of...) The time period covered by the invoice; and (vii) Total dollar amount itemized by budget categories...

  19. The TIAA Graded Payment Method and the CPI.

    ERIC Educational Resources Information Center

    King, Francis P.

    1995-01-01

    The graded payment method of receiving traditional annuity benefits was introduced by the Teachers Insurance and Annuity Association (TIAA) in 1982 to introduce an inflation-fighting factor into the annuity program. Under the graded method, in contrast to the standard method, a part of current annuity dividend income is withheld each year to…

  20. 38 CFR 10.50 - Section 601 and section 603 payments made on first day of calendar quarter.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... installment payments authorized in sections 601 and 603, respectively of title VI of the World War Adjusted... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Section 601 and section... shall any such payments be made before March 1, 1925: Provided, however, That payments authorized by...

  1. 38 CFR 10.50 - Section 601 and section 603 payments made on first day of calendar quarter.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... installment payments authorized in sections 601 and 603, respectively of title VI of the World War Adjusted... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Section 601 and section... shall any such payments be made before March 1, 1925: Provided, however, That payments authorized by...

  2. 38 CFR 10.50 - Section 601 and section 603 payments made on first day of calendar quarter.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... installment payments authorized in sections 601 and 603, respectively of title VI of the World War Adjusted... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Section 601 and section... shall any such payments be made before March 1, 1925: Provided, however, That payments authorized by...

  3. 38 CFR 10.50 - Section 601 and section 603 payments made on first day of calendar quarter.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... installment payments authorized in sections 601 and 603, respectively of title VI of the World War Adjusted... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Section 601 and section... shall any such payments be made before March 1, 1925: Provided, however, That payments authorized by...

  4. 38 CFR 10.50 - Section 601 and section 603 payments made on first day of calendar quarter.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... installment payments authorized in sections 601 and 603, respectively of title VI of the World War Adjusted... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Section 601 and section... shall any such payments be made before March 1, 1925: Provided, however, That payments authorized by...

  5. 49 CFR 375.221 - May I use a charge or credit card plan for payments?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false May I use a charge or credit card plan for... card plan for payments? (a) You may provide in your tariff for the acceptance of charge or credit cards for the payment of freight charges. Accepting charge or credit card payments is different than...

  6. 49 CFR 375.221 - May I use a charge or credit card plan for payments?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 5 2013-10-01 2013-10-01 false May I use a charge or credit card plan for... card plan for payments? (a) You may provide in your tariff for the acceptance of charge or credit cards for the payment of freight charges. Accepting charge or credit card payments is different than...

  7. 49 CFR 375.221 - May I use a charge or credit card plan for payments?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 5 2012-10-01 2012-10-01 false May I use a charge or credit card plan for... card plan for payments? (a) You may provide in your tariff for the acceptance of charge or credit cards for the payment of freight charges. Accepting charge or credit card payments is different than...

  8. 49 CFR 375.221 - May I use a charge or credit card plan for payments?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 5 2014-10-01 2014-10-01 false May I use a charge or credit card plan for... card plan for payments? (a) You may provide in your tariff for the acceptance of charge or credit cards for the payment of freight charges. Accepting charge or credit card payments is different than...

  9. 49 CFR 375.221 - May I use a charge or credit card plan for payments?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 5 2011-10-01 2011-10-01 false May I use a charge or credit card plan for... card plan for payments? (a) You may provide in your tariff for the acceptance of charge or credit cards for the payment of freight charges. Accepting charge or credit card payments is different than...

  10. 13 CFR 120.1881 - How are payments on the Collateral allocated between the SISMBD borrower and repayment of the...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... are payments on the Collateral allocated between the SISMBD borrower and repayment of the SISMBD Loan? Unless otherwise provided in the Loan Agreements for a particular SISMBD Loan, any payment on Collateral... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false How are payments on the Collateral...

  11. How to Hit a Home Run with Bundled Payments.

    PubMed

    Kaldy, Joanne

    2015-09-01

    As health care payment reform continues to evolve, reimbursement increasingly is being linked to outcomes as well as to expenditures. Toward this end, the Centers for Medicare & Medicaid Services has established models for "bundled" payments to long-term care providers, using predetermined payments based on historical spending rates, in a new pay-for-performance landscape. The goal is to reward providers for quality and cost-effective care as well as penalize them for adverse patient outcomes and hospital readmissions based on the target spending rates. Pharmacists have a role in these new models of care, but need to broaden their partnerships and relationships with providers and be prepared to prove they are contributing both to quality care and to reducing costs.

  12. 7 CFR 220.5 - Method of payment to States.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.5 Method of payment to States. Funds to be paid to any State for the School Breakfast Program shall be made available by means of Letters of...

  13. 7 CFR 220.5 - Method of payment to States.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.5 Method of payment to States. Funds to be paid to any State for the School Breakfast Program shall be made available by means of Letters of...

  14. Smart Money

    ERIC Educational Resources Information Center

    Ullman, Ellen

    2009-01-01

    From using virtualization technology to accepting lunch payments online, school districts are seeking money-saving methods. In this article, the author discusses some methods used by school districts that allow them to save money from using virtualization technology to accepting lunch payments online.

  15. Use of business planning methods to monitor global health budgets in Turkmenistan.

    PubMed Central

    Ensor, T.; Amannyazova, B.

    2000-01-01

    After undergoing many changes, the financing of health care in countries of the former Soviet Union is now showing signs of maturing. Soon after the political transition in these countries, the development of insurance systems and fee-for-service payment systems dominated the discussions on health reform. At present there is increasing emphasis on case mix adjusted payments in larger hospitals and on global budgets in smaller district hospitals. The problem is that such systems are often mistrusted for not providing sufficient financial control. At the same time, unless further planned restructuring is introduced, payment systems cannot on their own induce the fundamental change required in the health care system. As described in this article, in Tejen etrap (district), Turkmenistan, prospective business plans, which link planned objectives and activities with financial allocations, provide a framework for setting and monitoring budget expenditure. Plans can be linked to the overall objectives of the restructuring system and can be used to ensure sound financial management. The process of business planning, which calls for a major change in the way health facilities examine their activities, can be used as a vehicle to increase awareness of management issues. It also provides a way of satisfying the requirement for a rigorous, bottom-up planning of financial resources. PMID:10994288

  16. A Third-Party E-Payment Protocol Based on Quantum Group Blind Signature

    NASA Astrophysics Data System (ADS)

    Zhang, Jian-Zhong; Yang, Yuan-Yuan; Xie, Shu-Cui

    2017-09-01

    A third-party E-payment protocol based on quantum group blind signature is proposed in this paper. Our E-payment protocol could protect user's anonymity as the traditional E-payment systems do, and also have unconditional security which the classical E-payment systems can not provide. To achieve that, quantum key distribution, one-time pad and quantum group blind signature are adopted in our scheme. Furthermore, if there were a dispute, the manager Trent can identify who tells a lie.

  17. Mortality, Hospital Costs, Payments, and Readmissions Associated With Clostridium difficile Infection Among Medicare Beneficiaries

    PubMed Central

    Drozd, Edward M.; Inocencio, Timothy J.; Braithwaite, Shamonda; Jagun, Dayo; Shah, Hemal; Quon, Nicole C.; Broderick, Kelly C.; Kuti, Joseph L.

    2015-01-01

    Background The management of Clostridium difficile infection (CDI) among hospitalized patients is costly, and ongoing payment reform is compelling hospitals to reduce its burden. To assess the impact of CDI on mortality, hospital costs, healthcare use, and Medicare payments for beneficiaries who were discharged with CDI listed as a secondary International Classification of Diseases, Ninth Revision, Clinical Modification claim diagnosis. Methods Data were analyzed from the 2009 to 2010 5% random sample Medicare Standard Analytic Files of beneficiary claims. Patients with index hospitalizations with CDI as a secondary diagnosis and no previous hospitalization within 30 days were identified. Outcomes included inpatient and 30-day mortality, inpatient costs, index hospital payments, all-provider payments, net hospital losses, payment to cost ratio, length of stay (LOS), and 30-day readmission; outcomes were each risk adjusted using propensity score matching and regression modeling techniques. Results A total of 3262 patients with CDI were identified after matching to patients without a CDI diagnosis. After risk adjustment, secondary CDI was associated with statistically significantly (all P < 0.05) greater inpatient mortality (3.1% vs. 1.7%), 30-day mortality (4.1% vs. 2.2%), longer LOS (7.0 days vs. 3.8 days), higher rates of 30-day hospital readmissions (14.8% vs. 10.4%), and greater hospital costs ($16,184 vs. $13,954) compared with the non-CDI cohort. The risk-adjusted payment-to-cost ratio was shown to be lower for patients with CDI than those without (0.76 vs. 0.85). Conclusions Secondary CDI is associated with greater adjusted mortality, costs, LOS, and hospital readmissions, while receiving similar hospital reimbursement compared with patients without CDI in a Medicare population. PMID:27885315

  18. The insurance refund request: a legal analysis.

    PubMed

    Rollman, S O

    1998-12-01

    When an insurance payment is made erroneously to a healthcare provider and no contract between the insurer and provider addresses the issue of refunding such payments, the law relating to restitution generally applies. Restitution does not apply, however, to three exceptions that the courts have used to refuse claims by insurers for refunds of overpayments: the innocent third-party creditor exception, whereby the healthcare provider cannot be unjustly enriched by the overpayment, cannot have induced the mistaken payment, and cannot have known beforehand that the insurer was not obligated to pay; the material change in position exception, whereby the healthcare provider in good faith accepts an overpayment and so does not pursue other means of payment; and the assumption of the risk exception, which occurs when the insurer pays a claim without having complete information about it.

  19. The Economics of Provider Payment Reform: Are Accountable Care Organizations the Answer?

    PubMed

    Feldman, Roger

    2015-08-01

    A remarkable consensus has developed that the fee-for-service (FFS) approach for paying medical providers must be replaced. This payment approach is said to increase the volume of services without improving care coordination. In response to these calls, Medicare and private payers are experimenting with payment systems that combine the basic element of FFS - a fee for each service - with arrangements that allow providers to share the savings if they hold total spending per patient below a targeted amount. Medicare's accountable care organizations (ACOs) embody the shared savings approach to payment reform. Private payers have introduced total cost of care contracting (TCOC) in several locations. This article questions the consensus that FFS must go. If the fees are too high, then someone needs to "bite the bullet" and reduce fees in key areas. Hoping to control overspending by investment in ACOs is wishful thinking. I describe the theory and practice of shared savings payment systems and summarize recent TCOC contracting initiatives in the private sector. Medicare's shared savings approach is likely to be less effective than private contracts. Cutting providers' fees would be more efficient. Finally, the new payment models in the Affordable Care Act will not ease the problem of high prices for private payers. Copyright © 2015 by Duke University Press.

  20. 47 CFR 54.645 - Payment process.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false Payment process. 54.645 Section 54.645 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.645 Payment...

  1. 47 CFR 54.645 - Payment process.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Payment process. 54.645 Section 54.645 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.645 Payment...

  2. 42 CFR 415.102 - Conditions for fee schedule payment for physician services to beneficiaries in providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... case of radiology or laboratory services, the additional requirements in § 415.120 or § 415.130... conditions for payment for radiology services) and 415.130 (concerning conditions for payment for physician...

  3. 22 CFR 226.22 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.22 Payment. (a) Payment methods... recipient organization shall be limited to the minimum amounts needed and be timed to be in accordance with...

  4. 7 CFR 3430.51 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION... payments will be made in advance unless a deviation is accepted (see § 3430.3) or as specified in paragraph... Standard Application for Payments (ASAP) system, or another electronic funds transfer (EFT) method, except...

  5. Equity in out-of-pocket payment in Chile

    PubMed Central

    Mondaca, Alicia Lorena Núñez; Chi, Chunhuei

    2017-01-01

    ABSTRACT OBJECTIVE To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. METHODS Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. RESULTS Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. CONCLUSIONS In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity. PMID:28492762

  6. Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

    PubMed

    Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

    2016-06-01

    Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care.

  7. Out-of-Pocket Payments, Health Care Access and Utilisation in South-Eastern Nigeria: A Gender Perspective

    PubMed Central

    Onah, Michael N.; Govender, Veloshnee

    2014-01-01

    Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households. PMID:24728103

  8. Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective.

    PubMed

    Onah, Michael N; Govender, Veloshnee

    2014-01-01

    Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households.

  9. 75 FR 73169 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It finalizes the calendar year (CY) 2010 interim relative value units (RVUs) and issues interim RVUs for new and revised procedure codes for CY 2011. It also addresses, implements, or discusses certain provisions of both the Affordable Care Act (ACA) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In addition, this final rule with comment period discusses payments under the Ambulance Fee Schedule (AFS), the Ambulatory Surgical Center (ASC) payment system, and the Clinical Laboratory Fee Schedule (CLFS), payments to end-stage renal disease (ESRD) facilities, and payments for Part B drugs. Finally, this final rule with comment period also includes a discussion regarding the Chiropractic Services Demonstration program, the Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (CBP DMEPOS), and provider and supplier enrollment issues associated with air ambulances.

  10. The role of industry influence in sinus balloon dilation: Trends over time.

    PubMed

    Gadkaree, Shekhar K; Rathi, Vinay K; Gottschalk, Esther; Feng, Allen L; Phillips, Katie M; Scangas, George A; Metson, Ralph

    2018-05-08

    Balloon dilation (BD) is a controversial alternative to conventional sinus surgery. The role of industry on practice patterns remains unknown. The aim of this study was to determine whether industry payments from BD manufacturers influence practice patterns for otolaryngologists and evaluate how these payments change over time. Retrospective cohort study using Medicare Provider Utilization and Payment (PUP) Data and Center for Medicare and Medicaid Services Open Payments (OP) general payment datasets. A total of 294 otolaryngologists identified in the PUP dataset who performed BD procedures from January 1, 2013, to December 31, 2015, were cross-referenced in the OP dataset from January 1, 2014, to December 31, 2016, for BD manufacturer payments. Payments to surgeons performing BD stratified by amount, type, and number of procedures performed were primary outcome measures. Of the 294 otolaryngologists reporting BD procedures, 223 (76%) received payments from a company that manufactures BD devices. Receipt of $2,500 in BD payments was associated with performance of one additional BD procedure, and consulting fees were most positively associated with performing additional BD procedures (P = 0.006). The providers receiving the most in BD payments were more likely to continue to receive the most in payments, regardless of number of BD procedures performed. Performing more BD procedures did not correlate with decrease in other sinus procedures. Payments to otolaryngologists from manufacturers of sinus BD devices are associated with the performance of an increased number of such procedures. Surgeons should consider the impact of interactions with industry when evaluating patients for BD procedures. 4. Laryngoscope, 00:000-000, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

  11. 31 CFR 206.4 - Collection and payment mechanisms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... with these criteria, specific cash flows will utilize EFT as follows: (1) Fees/fines. EFT will be adopted as the presumed method of collecting fees and fines, especially when these collection cash flows... provide the Service with a recommended mechanism for any new or modified cash flows. The Service will...

  12. 31 CFR 206.4 - Collection and payment mechanisms.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... with these criteria, specific cash flows will utilize EFT as follows: (1) Fees/fines. EFT will be adopted as the presumed method of collecting fees and fines, especially when these collection cash flows... provide the Service with a recommended mechanism for any new or modified cash flows. The Service will...

  13. 31 CFR 206.4 - Collection and payment mechanisms.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... with these criteria, specific cash flows will utilize EFT as follows: (1) Fees/fines. EFT will be adopted as the presumed method of collecting fees and fines, especially when these collection cash flows... provide the Service with a recommended mechanism for any new or modified cash flows. The Service will...

  14. 31 CFR 206.4 - Collection and payment mechanisms.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... with these criteria, specific cash flows will utilize EFT as follows: (1) Fees/fines. EFT will be adopted as the presumed method of collecting fees and fines, especially when these collection cash flows... provide the Service with a recommended mechanism for any new or modified cash flows. The Service will...

  15. 76 FR 64049 - Bank Secrecy Act Regulations: Definition of “Monetary Instrument”

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-17

    ..., and anti-money laundering program requirements on providers and sellers of prepaid access. While the..., stated: \\13\\ See Money Laundering Using New Payment Methods, Financial Action Task Force, October 2010... Money Laundering Strategy stated that prepaid access is ``* * * an emerging cash alternative for both...

  16. Pay-per-view in interlibrary loan: a case study.

    PubMed

    Brown, Heather L

    2012-04-01

    Can purchasing articles from publishers be a cost-effective method of interlibrary loan (ILL) for libraries owing significant copyright royalties? The University of Nebraska Medical Center's McGoogan Library of Medicine provides the case study. Completed ILL requests that required copyright payment were identified for the first quarter of 2009. The cost of purchasing these articles from publishers was obtained from the publishers' websites and compared to the full ILL cost. A pilot period of purchasing articles from the publisher was then conducted. The first-quarter sample data showed that approximately $500.00 could have been saved if the articles were purchased from the publisher. The pilot period and continued purchasing practice have resulted in significant savings for the library. Purchasing articles directly from the publisher is a cost-effective method for libraries burdened with high copyright royalty payments.

  17. Refining Risk Adjustment for the Proposed CMS Surgical Hip and Femur Fracture Treatment Bundled Payment Program.

    PubMed

    Cairns, Mark A; Ostrum, Robert F; Clement, R Carter

    2018-02-21

    The U.S. Centers for Medicare & Medicaid Services (CMS) has been considering the implementation of a mandatory bundled payment program, the Surgical Hip and Femur Fracture Treatment (SHFFT) model. However, bundled payments without appropriate risk adjustment may be inequitable to providers and may restrict access to care for certain patients. The SHFFT proposal includes adjustment using the Diagnosis-Related Group (DRG) and geographic location. The goal of the current study was to identify and quantify patient factors that could improve risk adjustment for SHFFT bundled payments. We retrospectively reviewed a 5% random sample of Medicare data from 2008 to 2012. A total of 27,898 patients were identified who met SHFFT inclusion criteria (DRG 480, 481, and 482). Reimbursement was determined for each patient over the bundle period (the surgical hospitalization and 90 days of post-discharge care). Multivariable regression was performed to test demographic factors, comorbidities, geographic location, and specific surgical procedures for associations with reimbursement. The average reimbursement was $23,632 ± $17,587. On average, reimbursements for male patients were $1,213 higher than for female patients (p < 0.01). Younger age was also associated with higher payments; e.g., reimbursement for those ≥85 years of age averaged $2,282 ± $389 less than for those aged 65 to 69 (p < 0.01). Most comorbidities were associated with higher reimbursement, but dementia was associated with lower payments, by an average of $2,354 ± $243 (p < 0.01). Twenty-two procedure codes are included in the bundle, and patients with the 3 most common codes accounted for 98% of the cases, with average reimbursement ranging from $22,527 to $24,033. Less common procedures varied by >$20,000 in average reimbursement (p < 0.01). DRGs also showed significant differences in reimbursement (p < 0.01); e.g., DRG 480 was reimbursed by an average of $10,421 ± $543 more than DRG 482. Payments varied significantly by state (p ≤ 0.01). Risk adjustment incorporating specific comorbidities demonstrated better performance than with use of DRG alone (r = 0.22 versus 0.15). Our results suggest that the proposed SHFFT bundled payment model should use more robust risk-adjustment methods to ensure that providers are reimbursed fairly and that patients retain access to care. At a minimum, payments should be adjusted for age, comorbidities, demographic factors, geographic location, and surgical procedure.

  18. 76 FR 26678 - Withholding on Payments by Government Entities to Persons Providing Property or Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ... application of section 3402(t) to payments by debit cards, credit cards, stored value cards, and other payment cards. Proposed regulations under sections 3402(t), 3406, 6011, 6051, 6071, and 6302 of the Code were...

  19. 42 CFR 412.200 - General provisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Operating... the prospective payment system for inpatient operating costs. Except as provided in this subpart, the... for § 412.60, which deals with DRG classification and weighting factors, the provisions of subparts D...

  20. 47 CFR 1.1182 - Schedule of fees for products and services provided by the Commission in connection with...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Payment to auction contractor by credit card or check. (Public Notice will specify exact payment...) to same person or entity Payment to auction contractor by credit card or check. (Public Notice will...

  1. 47 CFR 1.1182 - Schedule of fees for products and services provided by the Commission in connection with...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Payment to auction contractor by credit card or check. (Public Notice will specify exact payment...) to same person or entity Payment to auction contractor by credit card or check. (Public Notice will...

  2. 47 CFR 1.1182 - Schedule of fees for products and services provided by the Commission in connection with...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Payment to auction contractor by credit card or check. (Public Notice will specify exact payment...) to same person or entity Payment to auction contractor by credit card or check. (Public Notice will...

  3. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

  4. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC...

  5. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

  6. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC...

  7. 7 CFR 1493.60 - Payment guarantee.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

  8. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount...

  9. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount...

  10. 32 CFR 32.22 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-owned business enterprises, recipients shall be encouraged to use women-owned and minority-owned banks... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 32.22 Payment. (a) Payment methods... Management Improvement Act (CMIA) (31 U.S.C. 3335 and 6503) or default procedures in 31 CFR part 205. (b...

  11. 15 CFR 14.22 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.22 Payment. (a) Payment methods... transfer of funds and disbursement by the recipient, and financial management systems that meet the... organization shall be limited to the minimum amounts needed and be timed to be in accordance with the actual...

  12. Medicare program: changes to the hospital outpatient prospective payment system and CY 2008 payment rates, the ambulatory surgical center payment system and CY 2008 payment rates, the hospital inpatient prospective payment system and FY 2008 payment rates; and payments for graduate medical education for affiliated teaching hospitals in certain emergency situations Medicare and Medicaid programs: hospital conditions of participation; necessary provider designations of critical access hospitals. Interim and final rule with comment period.

    PubMed

    2007-11-27

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. We describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2008. In addition, the rule sets forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system apply, and other pertinent rate setting information for the CY 2008 ASC payment system. Furthermore, this final rule with comment period will make changes to the policies relating to the necessary provider designations of critical access hospitals and changes to several of the current conditions of participation requirements. The attached document also incorporates the changes to the FY 2008 hospital inpatient prospective payment system (IPPS) payment rates made as a result of the enactment of the TMA, Abstinence Education, and QI Programs Extension Act of 2007, Public Law 110-90. In addition, we are changing the provisions in our previously issued FY 2008 IPPS final rule and are establishing a new policy, retroactive to October 1, 2007, of not applying the documentation and coding adjustment to the FY 2008 hospital-specific rates for Medicare-dependent, small rural hospitals (MDHs) and sole community hospitals (SCHs). In the interim final rule with comment period in this document, we are modifying our regulations relating to graduate medical education (GME) payments made to teaching hospitals that have Medicare affiliation agreements for certain emergency situations.

  13. Big things come in bundled packages: implications of bundled payment systems in health care reimbursement reform.

    PubMed

    Delisle, Dennis R

    2013-01-01

    With passage of the Affordable Care Act, the ever-evolving landscape of health care braces for another shift in the reimbursement paradigm. As health care costs continue to rise, providers are pressed to deliver efficient, high-quality care at flat to minimally increasing rates. Inherent systemwide inefficiencies between payers and providers at various clinical settings pose a daunting task for enhancing collaboration and care coordination. A change from Medicare's fee-for-service reimbursement model to bundled payments offers one avenue for resolution. Pilots using such payment models have realized varying degrees of success, leading to the development and upcoming implementation of a bundled payment initiative led by the Center for Medicare and Medicaid Innovation. Delivery integration is critical to ensure high-quality care at affordable costs across the system. Providers and payers able to adapt to the newly proposed models of payment will benefit from achieving cost reductions and improved patient outcomes and realize a competitive advantage.

  14. Medicare and Medicaid programs: hospital outpatient prospective payment; ambulatory surgical center payment; hospital value-based purchasing program; physician self-referral; and patient notification requirements in provider agreements. Final rule with comment period.

    PubMed

    2011-11-30

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) for CY 2012 to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we set forth the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other ratesetting information for the CY 2012 ASC payment system. We are revising the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, adding new requirements for ASC Quality Reporting System, and making additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. Finally, we are making changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

  15. Function-based payment model for inpatient medical rehabilitation: an evaluation.

    PubMed

    Sutton, J P; DeJong, G; Wilkerson, D

    1996-07-01

    To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes. This article describes a conceptual model, involving no data collection or data synthesis. The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team. The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.

  16. Creaming and Parking in Quasi-Marketised Welfare-to-Work Schemes: Designed Out Of or Designed In to the UK Work Programme?

    PubMed

    Carter, Eleanor; Whitworth, Adam

    2015-04-01

    'Creaming' and 'parking' are endemic concerns within quasi-marketised welfare-to-work (WTW) systems internationally, and the UK's flagship Work Programme for the long-term unemployed is something of an international pioneer of WTW delivery, based on outsourcing, payment by results and provider flexibility. In the Work Programme design, providers' incentives to 'cream' and 'park' differently positioned claimants are intended to be mitigated through the existence of nine payment groups (based on claimants' prior benefit type) into which different claimants are allocated and across which job outcome payments for providers differ. Evaluation evidence suggests however that 'creaming' and 'parking' practices remain common. This paper offers original quantitative insights into the extent of claimant variation within these payment groups, which, contrary to the government's intention, seem more likely to design in rather than design out 'creaming' and 'parking'. In response, a statistical approach to differential payment setting is explored and is shown to be a viable and more effective way to design a set of alternative and empirically grounded payment groups, offering greater predictive power and value-for-money than is the case in the current Work Programme design.

  17. Integrating care by implementation of bundled payments: results from a national survey on the experience of Dutch dietitians

    PubMed Central

    Tol, J.; Swinkels, I.C.S.; Struijs, J.N.; Veenhof, C.; de Bakker, D.H

    2013-01-01

    Introduction In the Netherlands, bundled payments were introduced as part of a strategy to redesign chronic care delivery. Under this strategy new entities of health care providers in primary care are negotiating with health insurers about the price for a bundle of services for several chronic conditions. This study evaluates the level of involvement of primary health care dietitians in these entities and the experienced advantages and disadvantages. Methods In August 2011, a random sample of 800 Dutch dietitians were invited by email to complete an online questionnaire (net response rate 34%). Results Two-thirds participated in a diabetes disease management programme, mostly for diabetes care, financed by bundled payments (n=130). Positive experiences of working in these programmes were an increase in: multidisciplinary collaboration (68%), efficiency of health care (40%) and transparency of health care quality (25%). Negative aspects were an increase in administrative tasks (61%), absence of payment for patients with comorbidity (38%) and concerns about substitution of care (32%). Discussion/conclusion Attention is needed for payment of patients with co- or multi-morbidity within the bundled fee. Substitution of dietary care by other disciplines needs to be further examined since it may negatively affect the quality of treatment. Task delegation and substitution of care may require other competencies from dietitians. Further development of coaching and negotiation skills may help dietitians prepare for the future. PMID:24399924

  18. Understanding informal payments in health care: motivation of health workers in Tanzania

    PubMed Central

    Stringhini, Silvia; Thomas, Steve; Bidwell, Posy; Mtui, Tina; Mwisongo, Aziza

    2009-01-01

    Background There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Methods Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package. Results The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention. Conclusion This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also tackles an environment in which corruption is endemic. PMID:19566926

  19. Competitive bidding for health insurance contracts.

    PubMed

    Keijser, G M; Kirkman-Liff, B L

    1992-05-01

    The determination of the payment or premium to be paid to the insurer by a large purchaser of care must accurately represent the risk of the enrolled persons. One approach is a risk-adjusted payment established by a mathematical formula, which estimates the effect of many variables on total care costs, and for different groups of persons determine an average cost. This method has several problems, and an alternative is competitive bidding. Market forces pressure providers to offer the lowest possible bids while attempting to remain fiscally viable and provide high-quality services. Research from the U.S. demonstrates that competitive contracting effectively lowered the costs of health care for those sectors of the health care system that used this strategy. Bidding by area gave far more equitable results than could have been obtained with a state-wide system with crude adjustments for each area. It is an alternative which can create strong incentives for innovation and cost-containment, and at the same time allows insurers to take into account local variation in supply and demand of care. As a potential alternative to a regulatory system, competitive bidding should be considered for regional experimentation in health insurer payment.

  20. 42 CFR 409.100 - To whom payment is made.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... insurance benefits only to a participating provider. (2) For home health services (including medical... PROGRAM HOSPITAL INSURANCE BENEFITS Payment of Hospital Insurance Benefits § 409.100 To whom payment is... or consulting arrangement). (b) Exceptions. Medicare may pay hospital insurance benefits as follows...

  1. 42 CFR 415.130 - Conditions for payment: Physician pathology services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Conditions for payment: Physician pathology... Physician Services to Beneficiaries in Providers § 415.130 Conditions for payment: Physician pathology... of physician pathology services to fee-for-service Medicare beneficiaries who were hospital...

  2. 14 CFR 151.129 - Payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... FEDERAL AID TO AIRPORTS Rules and Procedures for Advance Planning and Engineering Proposals § 151.129 Payments. (a) The United States' share of advance planning costs is paid in two installments unless the advance planning grant agreement provides otherwise. Upon request by sponsor, the first payment may be...

  3. 42 CFR 415.164 - Payment to a fund.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) MEDICARE PROGRAM SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.164 Payment to a fund. (a) General rules. Payment for certain voluntary services by physicians in teaching hospitals (as...

  4. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

  5. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

  6. 7 CFR 1493.450 - Payment guarantee.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

  7. 36 CFR 228.65 - Payment for sales.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Payment for sales. 228.65 Section 228.65 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.65 Payment for sales. (a) Conditions...

  8. 36 CFR 228.65 - Payment for sales.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Payment for sales. 228.65 Section 228.65 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.65 Payment for sales. (a) Conditions...

  9. 36 CFR 228.65 - Payment for sales.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Payment for sales. 228.65 Section 228.65 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.65 Payment for sales. (a) Conditions...

  10. 36 CFR 228.65 - Payment for sales.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Payment for sales. 228.65 Section 228.65 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.65 Payment for sales. (a) Conditions...

  11. 36 CFR 228.65 - Payment for sales.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 2 2013-07-01 2013-07-01 false Payment for sales. 228.65 Section 228.65 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Disposal of Mineral Materials Types and Methods of Disposal § 228.65 Payment for sales. (a) Conditions...

  12. 76 FR 53137 - Bundled Payments for Care Improvement Initiative: Request for Applications

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-25

    ... (RFA) will test episode-based payment for acute care and associated post-acute care, using both retrospective and prospective bundled payment methods. The RFA requests applications to test models centered around acute care; these models will inform the design of future models, including care improvement for...

  13. 20 CFR 416.532 - Method of payment when the essential person resides with more than one eligible person.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... State may report that the person is essential to one or both members of the couple. In either event, the... payment increment attributable to the essential person will be added to the rate of payment for the couple...

  14. 42 CFR 447.202 - Audits.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Audits. 447.202 Section 447.202 Public Health... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment Methods: General Provisions § 447.202 Audits. The Medicaid agency must assure appropriate audit of records if payment is based on costs of services or on a fee plus...

  15. 14 CFR 1261.411 - Collection in installments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... method, including voluntary payment. However, if the debtor is financially unable to pay the indebtedness... unable to pay the debt in one lump sum must submit financial statements. If NASA agrees to accept payment... relation to the size of the debt and the debtor's ability to pay. If possible, the installment payments...

  16. 14 CFR 1261.411 - Collection in installments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... method, including voluntary payment. However, if the debtor is financially unable to pay the indebtedness... unable to pay the debt in one lump sum must submit financial statements. If NASA agrees to accept payment... relation to the size of the debt and the debtor's ability to pay. If possible, the installment payments...

  17. 48 CFR 1215.404-470 - Payment of profit or fee.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Payment of profit or fee. 1215.404-470 Section 1215.404-470 Federal Acquisition Regulations System DEPARTMENT OF TRANSPORTATION CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1215.404-470 Payment of...

  18. 24 CFR 232.580 - Application of payments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... instrument shall provide that all monthly payments to be made by the borrower shall be added together and... shall constitute an event of default and the loan shall further provide for a grace period of 30 days...

  19. 24 CFR 232.580 - Application of payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... instrument shall provide that all monthly payments to be made by the borrower shall be added together and... shall constitute an event of default and the loan shall further provide for a grace period of 30 days...

  20. 24 CFR 232.580 - Application of payments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... instrument shall provide that all monthly payments to be made by the borrower shall be added together and... shall constitute an event of default and the loan shall further provide for a grace period of 30 days...

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