Quote:
Originally Posted by BrianL99
That wasn't the question.
The question is, does Medicare for Advantage plans pay a "lump sum per patient" (as Rainger said) or do they pay per individual visit/procedure (as OBB said)?
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Quote:
Originally Posted by spinner1001
Pay who? The MA plan or clinic?
Regardless, neither described by Rainger and OBB is necessarily true for MA. If the MA financial model were simple, there would be less disagreement and confusion.
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Based on the fact that Medicare is saying TVH "over-billed" them, that must mean that Medicare pays TVH directly (which surprises me). It sounds like the Insurance carrier is just a "middle man", providing management of the patient/doctor relationship.
With 100's of posts on the subject, it seems someone must actually know the formula for how TVH gets it's revenue and from whom. Again, Rainger & OBB's characterizations of the payment structure/arrangement are diametrically opposed ... two separate and distinct arrangements.
Does Medicare pay TVH a specific amount per patient, regardless of what or how many procedures they have (adjusted only for bonuses and/or "complexity" level of their conditions) ....
Or ... does Medicare pay TVH per visit and/or per procedure, as OBB claimed in the bunion story.
& how does the insurance company get paid, if they're not billing Medicare directly?
Call me crazy, but if no one understands how billing and payments actually work, how does anyone have an opinion on who's getting pork'd and how?