Cost-related or cost-based reimbursement

One method of payment of medical care programs by third j)arties, typically Blue Cross plans or government agencies, for services delivered to patients. In cost-related systems, the amount of the payment is based on the costs to the provider of delivering the service. The actual payment may be based on any one of several different formulae, such as full cost, full cost plus an additional percentage, allowable costs, or a fraction of costs. Other reimbursement schemes are based on the charges for the services delivered, or on budgeted or anticipated costs for a future time period {prospective reimbursement). Medicare, Medicaid, and some Blue Cross plans reimburse hospitals on the basis of costs; most private insurance plans pay charges.


 


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