Essay on Quiz Review
The first party is the patient himself or herself or the person, such as a parent, responsible for the patient’s health bill. The second party, often called providers is the physician, clinic, hospital, nursing home, or the healthcare entity rendering the care. The third party is the payer, and uninvolved insurance company or health agency that pays the physician, clinic, or other secondary party provider for the care or services rendered to the first party. 2. Compare the UCR and the CPR payment systems.
The usual, customary, and reasonable (UCR) is one version of discounted fee-for-service payment method. The UCR is a type of fee-for-service payment method in …show more content…
True, in the Beveridge model, the government owns many hospitals and some doctors and health personnel are government employees and in the Bismarck model, everybody is in a type of universal coverage.
1. Who are the first, second, and third parties in healthcare situations?
The first party is the patient or person responsible for the bill. The second party is the provider (physician, clinic, hospital, nursing home, etc.) or other healthcare entity rendering care. The third party is the uninvolved insurance company or health agency that pays for the care or services rendered.
2. Compare the UCR and CPR payment systems.
Both UCR and CPR were used to manage costs related to fee-for-service payments. Private insurance companies used UCR, which is the provider’s usual charge for a service, the amount customarily charged by other providers in the community, and the reasonable cost of the service following review of the case. Medicare used CPR, which is the provider’s customary charge for the service during the previous year, the prevailing charge of 75% of other providers in the area, and the reasonable charge, which was the smallest of the actual customary, and prevailing charge.
3. Describe the two purposes of