10/29/2023 0 Comments Mtty lucent![]() When this occurs the plan also provides an estimate of payment to the facility. The plan requires pre-approval for these procedures by calling into a Utilization Review organization. For procedures performed in a facility, this begins during the pre-certification process. This results in a lowered cost of care for everyone involved. In a VBP plan, Facility claims are repriced based on a percentage of Medicare payment. ![]() ![]() In this model, the PPO negotiates a contract with a facility and any claims incurred are paid based on that contract.
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