Overview: Healthcare REIMBURSEMENT SYSTEMS CAN BE COMPLEX AND
DIFFICULT TO UNDERSTAND. Each payor may use a different method to
reimburse providers, or they may use a variation of a commonly used
method. This course will provide a foundation for understanding the
common REIMBURSEMENT SYSTEMS IN USE TODAY. We start with Medicare's
REIMBURSEMENT SYSTEMS OF RBRVS, DRGs, and APCs because many other
payors use modified versions of these systems. We then discuss other
payor types such as HMOs, PPOs, and ACOs and how these organizations
use other REIMBURSEMENT METHODS SUCH AS CAPITATION, per diems, and
carve outs. Finally, we discuss the key data elements needed to
adjudicate claims according to each scheme, and we discuss the
financial incentives (and disincentives) associated with each method.
Why you should Attend: This webinar is beneficial for anyone who works
with medical claims and who wants a better understanding of the
differences between charges and allowed amounts, how health plans and
payors adjudicate claims, and how providers and payors use
REIMBURSEMENT METHODS TO ALIGN INCENTIVES TO MANAGE COST AND QUALITY.
This session is also useful for provider and health plan contract
managers and directors who want to build on their understanding of
REIMBURSEMENT MECHANISMS AND WHO WANT TO IMPROVE THEIR CONTRACT
NEGOTIATION SKILLS. Areas Covered in the Session: Prospective Payment
Systems: DRG and APC based REIMBURSEMENT Typical hospital contracting
structures: per diem, per stay, carve outs, case rates,
minimum/maximums, etc. Physician fee schedules and fee maximums,
RBRVS, RVUs and capitation Major payor types (Medicare, Medicaid, HMO,
PPO, ACO, etc.) and how they reimburse providers Who Will Benefit:
Health Plan and Provider CFOs Analysts Provider Contract Managers
Claim Examiners REIMBURSEMENT DIRECTORS Payment Integrity Managers
Revenue Managers Rich Henriksen - MentorHealthSpeaker Profile Rich
Henriksen is the Chief Executive Officer and Founder of Nokomis
Health. Rich has 30 years of experience in healthcare systems, coding,
billing, and REIMBURSEMENT. He has led managed care departments and
provider contracting units at a variety of organizations, including
hospitals, clinics, and health plans. Event link:
https://www.mentorhealth.com/webinar/-801898LIVEchannel=eventful-FEB_2020_SEO
[https://www.mentorhealth.com/webinar/-801898LIVE?channel=eventful-FEB_2020_SEO]
Contact Info: Netzealous LLC - MentorHealth Phone No: 1-800-385-1607
Fax: 302-288-6884 Email: mentorhealth84@gmail.com Website:
http://www.mentorhealth.com/ [http://www.mentorhealth.com/]
business
959
Views
07/02/2020 Last update