Disability insurance expert witnesses may opine on health insurance, medical insurance, managed care, and more. In Managed Care Fact Sheets, experts at the health care publisher MCOL describe provider payment arrangements:
Incurred but not reported claims or encounters involve covered services that have been rendered, but have not been received or captured by you to process. You to need to consider this issue when:
* You pay claims from sub-contracted or outside providers.
* You capitate sub-contracted providers and collect encounter data from them.
* You provide internal services and capture your encounter data, or even pay yourself from a shared risk fund.
Pay for Performance (P4P) involves various types of incentive reimbursement programs that tie financial rewards to various types of improved outcomes. This typically means purchasers pay participating providers different levels of payment, based upon provider performance with specified sets of measures that often include quality, patient satisfaction, efficiency and adoption of desired information technology. P4P provider reimbursement can involve fixed or variable bonus payments, changes to base payments for services rendered, withholds, and even non-financial rewards.
For more, see mcol.com.