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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
In July 2009, a Special Commission on the Health Care Payment System in Massachusetts distinguished between episode-based payments (i.e., bundled payments) and "global payments" that were defined as "fixed-dollar payments for the care that patients may receive in a given time period... plac[ing] providers at financial risk for both the ...
The range of time for this care varies but the bundling time can start 3 days prior to the acute care. [20] One of the advantages of the bundled payment program is that it incentivizes hospitals not to discharge patients too early, as the post-acute care facility will just have to deal with the implications that come with that. [20]
The care must be part-time or intermittent. Translation: less than eight hours a day or generally under 28 hours a week. (Medicare permits care up to 35 hours a week on a case-by-case basis.)
Reimbursement is the act of compensating someone for an out-of-pocket expense by giving them an amount of money equal to what was spent. [1]Companies, governments and nonprofit organizations may compensate their employees or officers for necessary and reasonable expenses; under US [2] [3] law, these expenses may be deducted from taxes by the organization and treated as untaxed income for the ...
Pay dispersion is defined as the ‘differences in pay levels between individuals within (i.e., horizontal dispersion) and across (i.e., vertical dispersion) jobs or organisational levels. [22] Vertical pay dispersion is specifically the difference in remuneration between the most senior employees of an organisation (e.g., Executive Directors ...
Additionally, reimbursement for physician visits can be complicated and result in non-payment to physicians. [91] [92] Therefore, difficulty in authorizing expensive treatments and lack of payment for visits can be reasons for non-referral from a physician. Nursing Homes: A second aspect to reimbursement pertains to the nursing home. In many ...
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