BUILDING BLOCKS > Provider payment

Provider Payment Setting

What mechanisms are used to determine payment amounts for medical services that both supports high-quality care and incentivizes efficiency?

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Government Regulation

How does the government determine payment levels to fairly compensate hospitals, doctors, or other healthcare providers for rendering medical services?

Policy Definition: Government regulations for setting levels of payment is the method that Medicare and Medicaid uses to pay hospitals, doctors, and other providers. source

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Payor/Provider Negotiation

How does the private payors and providers negotiation process set payment levels to fairly compensate hospitals, doctors, or other healthcare providers for rendering medical services?

Policy Definition: Negotiation is the approach typically used by commercial insurers to determine how much they will pay providers. In many cases, insurers use Medicare’s payment methodology and even the same relative values among services; what is negotiated is called the “conversion factor.” source

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