What is the difference between MCO and FFS?

MCO refers to risk-based managed care; PCCM refers to Primary Care Case Management. FFS/Other refers to Medicaid beneficiaries who are not in MCOs or PCCM programs.

What are the key differences between fee-for-service and managed care?

Under the FFS model, the state pays providers directly for each covered service received by a Medicaid beneficiary. Under managed care, the state pays a fee to a managed care plan for each person enrolled in the plan.

What is the main difference between traditional and managed fee-for-service reimbursement?

The main difference between a managed health care plan and a traditional fee-for-service health insurance plan is that managed health care plans are dependent on a network of key players, including health care providers, doctors, and facilities that establish a contract with an insurance provider to offer plans to …

What is FFS or managed care?

In fee-for-service (FFS), a health plan is not involved in managing the cost of a person’s care. Instead, states pay claims individually as providers deliver and bill for services and care. When states provide LTSS under a managed care model, they experience: Increased budget certainty.

What is managed fee-for-service?

Under the FFS model, the Centers for Medicare & Medicaid Services (CMS) and a state enter into an agreement through which the state would be eligible to benefit from savings resulting from initiatives that improve quality and reduce costs for both Medicare and Medicaid.

Is Medicare a service fee?

Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles). or Medigap.

What is fee-for-service Medicaid in Michigan?

Fee-for-service is the term for Medicaid paid services that are not provided through a health plan. This means that Medicaid pays for the service. People under fee-for-service will use the mihealth card to receive services. Most people must join a health plan.

What are the pros and cons of fee-for-service?


Pros Cons
Encourages the delivery of care and maximizing patient visits Offers little or no incentive to deliver efficient care or prevent unnecessary care

Is fee-for-service good?

Economists argue that fee-for-service is inefficient and incentivizes providers to do more (tests, procedures, visits) than necessary to increase revenue. The model rewards the most expensive interventions, at the cost of preventive care, behavioral health services and disease management.

What is wrong with fee-for-service?

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