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The Expansion Of The Maryland All Payer Model

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The topic being researched in this paper is the Maryland All Payer Model. The reason for reviewing this topic is to better understand the payment system for the state in which I live. I was born and raised in the state of Maryland. Like other residents of Maryland and an insurer, I not always as aware of the things that affect me personally. In conversations had, along with some understanding of the process of how the revenue cycle works, I believed that not only would this be a topic that can bring personal awareness for myself but also help to understand the Maryland payer system for career growth. The current payment system is an expansion of a program that Maryland has already been practicing for many years now. This research will help …show more content…

This change was a part of the Medicare expansion for the state and a means of bring a better more patient centered focus to healthcare According to CMS (2014), the decision was made to implement the expansion of the All payer model in Maryland in January of 2014. This was a collaboration between the state of Maryland and Center of Medicare and Medicare Services (CMS). This model was initiated as a way to update Maryland’s prior payment system. This All Payer model is an updated way for Maryland to regulate and set cost for hospital services. Understanding the efficacy and effectiveness of this model would allow one to understand why the change of this system was necessary for the state of …show more content…

The prior payment system that Maryland used was the Maryland Medicare waiver system. According to CMS (2017), the All Payer system was possible due to the Medicare waiver that exempts Maryland from having to follow the rules provided under the Inpatient Prospective Payment System and the Outpatient Prospective Payment Systems. CMS states, the Inpatient Prospective System is a system that regulates inpatient services based on the diagnosis related group (DRG) the service fell into. These DRG’s had a payment weight that would determine how a case would be reimbursed. The Maryland Health Service Cost Review Commission also known as HSCRC, was the body that was created in the means of setting rates and regulating the cost of care for the state. Maryland was one of the first and only state in the country to design their healthcare payment system to operate in this way. The original payment system was created to focused on services being paid a regulated rate per admission case. It was designed to have services paid per case and have the hospitals be paid based on the amount of inpatient admissions

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