Group_discussion_inpatient_and_outpatient
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Davenport University *
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250
Subject
Health Science
Date
Dec 6, 2023
Type
docx
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2
Uploaded by khodges7
1
1.
What payment and reimbursement systems could apply to the case (example: per
diem) based on the case setting (outpatient and inpatient)?
When a patient comes into a facility as an inpatient and outpatient scenario it is important to
get all the patients information. Knowing certain information will dictate how charging and
reimbursement will come into play. In this scenario (#9) the patient does not have any
information listed for insurance. This patient would not be required to pay a co-pay that is
sometimes required a patient to pay by an insurance company. With the listed main diagnosis and
an assignment of a severity of Illness, MS-DRG could be enlisted to assign charges and with a
secondary diagnosis and a procedure the level of severity could be raised to a higher level. This
could also be charged as per diem which charges a daily fixed rate instead of the MS-DRG that
charges based on procedure (Casto & White, 2021).
The outpatient (#1) has worker’s compensation that will receive a bill for the patients stay
and procedure. This could fall under retrospective reimbursement, which is based on the actual
resources expended to deliver the services and is finalized after services are delivered. With
workman’s compensation there is usually a case manager that this will go through before the
reimbursement is handled. When billing them they can bill with MS-DRG so that the workman’s
compensation is billed for one set procedure price with different levels that can be added as well
(Casto & White, 2021). (Written by Kelly).
2
References
Casto, A. B., & White, S. (2021). Principles of Healthcare Reimbursement and Revenue Cycle
Management.
AHIMA
. 7
th
Edition.
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