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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

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


Payor/Provider Negotiation

Policy Definition: Payer/provider 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. The negotiated rate is called the “conversion factor.” source


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