“HA3120D – Essentials of Managed Care

 LP04 Assignment: Physician Reimbursement

Directions
With the increasing cost of health care, MCOs have been under tremendous pressure to control health care costs, including physician reimbursement. In this assignment, you are to look at some of the issues that are involved in physician reimbursement.

Your assignment is to write a paper that addresses the following:
• What are the different methods that MCOs reimburse providers for health care services?
• How does reimbursement for these services vary based on the type of MCO models (Group, Staff, IPA, PPO…)
• In which situations would members/patients pay the MCO directly?
• How do you think reimbursement impacts how care is delivered to the patient?
• Is this good or bad? Provide examples,
• Cite your resources.

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