her approaches to managed care; the diagnosis related groups reimbursement system (DRG); and the designation of preferred provider organizations (PPOs).
Retrospective reimbursement is the traditional method of settling hospital charges in the United States. The retrospective technique provides for the reimbursement of health care providers on the basis of after the fact determinations. Prospective reimbursement, conversely, provides for a pre negotiated fee for health care services which are to be provided. Variations of the prospective reimbursement technique have been implemented by the federal government, some state governments, and by joint agreement between some third party insurers and hospitals.
The intent of the hospital utilization review technique is to reduce the incidence of inappropriate or unnecessary hospitalization. The hospital utilization review technique may be used with either a retrospective or a prospective reimbursement technique. When it is used with a prospecti
...