Episodes of Care Increasingly Used in Healthcare Payments

graphic-chart-people.jpgBy: Karina Gonzalez

Presently, payment for healthcare services is governed by the use of thousands of codes which describe a specific medical activity.  Payment is made on a fee for service basis based on the medical activity or service rendered. Capitation payments are also used in managed care in which providers are paid a lump sum per patient regardless of how many services the patient received.  Increasingly, payment is being shifted to an episode of care concept and used interchangeably with bundled payments or case rate payments.  These are generally defined on the basis of expected costs for clinically defined episodes of care.   An episode of care can range from a few days to a year and the patient will receive care from multiple providers who treat a particular condition over the length of time it takes to address the specific ailment. An episode of care payment is a single price paid for all the services needed by a patient.  Continue reading

Standing Orders in Drug Treatment Programs: How to Avoid Waving a Red Flag

so 2014By: Karina P. Gonzalez

Medical necessity is the driving force for the payment of any service, but is especially worth noting when discussing laboratory testing. Standing Orders for urine drug testing in residential treatment settings are not prohibited, per se, but this practice must be built upon detailed policies and procedures that are precisely followed and are directed to individual patient needs.

The following conditions may help to determine whether Standing Orders are appropriate in a residential treatment setting: Continue reading