WHAT DOES MEDICAID FFS STAND FOR?

Medicaid Fee for service (FFS) is the most convenient way of paying for healthcare services. This is a payment model which helps physicians to get reimbursement for their services provided to patients. The only setback of this payment system is that every time a patient visits the clinic, their insurance providers are billed for every consultation, procedure, or treatment. This way physicians will be rewarded for the number of services they provide, regardless of the desired treatment outcomes or quality medical care.

Let’s have a deep understanding of the fees for the service health plan of Medicaid:

In general terms, states directly pay for the Medicaid services provided by the physicians, hospitals, clinics, and other healthcare services providers to the patients. This payment model is a reward system for the healthcare providers as the more services they provide, the more money they will get. Irrespective of the quality of medical care or the patient outcomes. To improve patient care, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that improves patient-centered care, health management, and quality accountability of patients.

FFS model may be cumbersome for insurance providers as finances charged to them depend upon the number of offered services that potentially incentivize the medical care providers to schedule more appointments regardless of irrelevant medical procedures. Additionally, the gain per patient may vary as some patients require no care at all while others require an extensive amount of care. This way, FFS can be a costly and volume-based system for both patients and doctors.

Looking at these requirements, Capitation may be a cost-effective option to FFS in some conditions. Many healthcare providers believe that FFS combines with capitation can help in growing practice and is important for a good running healthcare practice. The right payment mode depends upon certain factors like location, specialities of a doctor, patient demographics, health maintenance organization (HMO), etc. Here we will check certain advantages and disadvantages of capitation FFS to check if it is a feasible option or not.

The meaning of FFS is “pay the medical care provider first”. It is an arrangement that offers reimbursement for bundled healthcare services irrespective of the quality of care provided. In old days, doctors charge their patients when they felt that the services are necessary for patients and patients paid them directly. The costs were a part of good quality healthcare provided to patients. But, these days. good quality medical care is no longer a bug and now doctors charge for the number of times they have offered the services. FFS may create uncertain financial incentivize the providers to schedule a number of services unnecessary medical procedures. However with capitation. medical care providers are reimbursed depending upon the timeframe of treatment. Capitation is a healthcare quality-based payment system intended to offer efficiency-based payment with cost control to offer the best possible health care. Comparing with FFS, capitation is a far better financial payment method of reimbursement.

Talking about the disadvantages, according to the top medical providers, FFS could be slightly costly and an ineffective payment model. Many healthcare experts suggest that in modern times, there are so many complications in the healthcare system and the requirements of the medical service of individuals with chronic disease have outdates the capability of fee for services. This payment model offers no reward to doctors offering holistic or value-based medical care. Even it incentivize doctor to perform unnecessary tests to generate more money.

Hope this blog has helped you to understand the merits and demerits of the FFS system. To know more check our other blogs.

Ref:

• https://www.ventureforthe.com/insurance-options/medicaid-ffs/
• https://prognocis.com/what-is-fee-for-service-in-healthcare/
• https://www.macpac.gov/medicaid-101/provider-payment-and-delivery-systems/
• https://www.helpadvisor.com/medicaid/ffs
• https://www.revenuexl.com/blog/fee-for-service
• https://prognocis.com/capitation-vs-fee-for-service-healthcare-payment-models/