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patient, the length of the hospital stay, or the number and type
of medical supplies used. Additional payments, however, may be
made to hospitals for discharges involving an extremely long stay
or unusually high costs when compared to most discharges
classified in the same DRG. Managed care networks, HMO's, and
some insurance companies also employ similar reimbursement
practices.
Between 70 and 80 percent of hospital bills are paid on the
basis of DRG’s or some other negotiated per case or per diem
basis. In most cases, the itemized bill does not bear any
particular relationship to the amount that actually will be due
the hospital for the services provided. Hospitals, however,
continue to detail charges in their bills because Medicare and
insurance companies continue to require such itemization.
Insurers pay some types of hospital stays based on detailed
itemized charges, such as outpatient hospital stays and
psychiatric stays. Uninsured patients with the ability to pay
are presented with a complete bill and may be held liable for
payment of the full amount.
For most of their income, hospitals contemplate receiving
two or more payments on behalf of the patient, consisting of one
or more payments from third-party payers and one or more payments
of a deductible or copayment amount by the patient.
Petitioners' Accounting System
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