Reimbursement Options

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Develop a 3-5-page review of the various reimbursement options that a large primary care office would have for the charges associated with a new patient consult.




  • Casto, A. B., & Forrestal, E. (2015). Principles of healthcare reimbursement (5th ed.). Chicago, IL: AHIMA Press.
    • Chapter 7, “Ambulatory and Other Medicare—Medicaid Reimbursement Systems,” pages 147–204. This chapter may help you to better differentiate between the main Medicare and Medicaid reimbursement systems, as well as define the basic terminology and models associated with these systems.
    • Chapter 1, “Healthcare Reimbursement Methodologies,” pages 1–26. Review this chapter as needed to refresh your understanding on the basic vocabulary and methods for health care reimbursement in the U.S.
  • Rosenthal, M. B. (2007). Pay for performance and beyond. Expert Review of Pharmacoeconomics & Outcomes Research, 7(4), 351–355.
    • This article examines the foundations of pay for performance and how an outcomes-based reimbursement scheme could change the health care landscape.
  • Mongan, J. J., Ferris, T. G., & Lee, T. H. (2008). Options for slowing the growth of health care costs. The New England Journal of Medicine, 358(14), 1509–1514.
    • This article examines various strategies to help control the costs of health care.
  • McKethan, A., & Jha, A. K. (2014). Designing smarter pay-for-performance programs. JAMA, 312(24), 2617–2618.
    • This article presents some of the failures of recent pay for performance programs and proposes possible considerations to make future programs more effective.
  • Rosenthal, M. B., Landrum, M. B., Robbins, J. A., & Schneider, E. C. (2016). Pay for performance in Medicaid: Evidence from three natural experiments. Health Services Research, 51(4), 1444–1466.
    • This article examines the impacts and evidence from three pay-for-performance programs related to Medicaid. The findings were mixed as to the benefit and quality improvements of the programs.

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