Recommendations for Collecting Payer Information on Plan Benefit Design and Payments to Providers for Non-Claims based Services

This study points out some challenges for constructing total cost of care estimates as payors (insurers, employers) evolve from reimbursing health care providers mainly through fee-for-each-service (FFS) payment systems to reimbursements that reflect bundles of services, including episodes of care and global contracts, and shared savings payments, which are not priced in FFS claims databases.

Do you know employers who get, or plan to request, from their insurer/third party administrator payments made to providers outside the FFS system? Other comments?

APCD Council, UNHIHPP, and NAHDO, Recommendations for Collecting Payer Information on Plan Benefit Design and Payments to Providers for Non-Claims based Services, September 2014.

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