Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Billing Process of Various Health Care Enterprises
Slide content:Prospective Payment Types Per-diem: Fixed payment made for each day of hospitalization i.e. based on unit of time Case-based: Fixed amount for providing health services for a condition or disease (case) 17
Slide notes:There are two prospective payment types. The first is per-diem payment, in which a fixed amount is paid for each day of hospitalization, where the day represents the episode of care. The second type of prospective payment is case-based payment where the same amount is paid regardless of the length of stay and total resource use. For example, two patients with pneumonia are admitted to the hospital on the same day. The first requires five days of hospitalization and the second requires nine days of hospitalization. With per-diem payments, the hospital receives five times the per diem payment for the first patient, and nine times the per diem rate for the second patient. Under case-based payment, the organization receives the same amount for both patients, even though one required additional days of care. 17