Chapter 17 Reimbursement Procedures Getting Paid Chapter outline I. Understanding Reimbursement Systems A. Types of Reimbursement 1. Fee-for-Service 2. Discounted Fee-for-Service 3. Prospective Payment System 4. Relative Value Units 5. Managed Care Organizations 6. Capitation II. Medicare and Reimbursement…
Chapter 3 The Legal and Ethical Side of Medical Insurance Chapter outline I. Medical Law and Liability A. Employer Liability B. Employee Liability II. Insurance and Contract Law A. Elements of a Legal Contract 1. Offer…
Chapter 5 Claim Submission Methods Chapter outline I. Overview of the Health Insurance Claims Process A. Two Basic Claims Submission Methods B. Proposed Revisions to the CMS-1500 (08-05) Form II. Electronic Claims III. Health Insurance…
Chapter 7 Unraveling the Mysteries of Managed Care Chapter outline I. What Is Managed Care? II. Common Types of Managed Care Organizations A. Preferred Provider Organization B. Health Maintenance Organization 1. Staff Model 2. Group Model…
Chapter 6 Traditional Fee-for-Service/Private Plans Chapter outline I. Traditional Fee-for-Service/Indemnity Insurance II. How a Fee-for-Service Plan Works III. Healthcare Reform and Preexisting Conditions A. HIPAA and Credible Coverage IV. Commercial or Private Health Insurance A. Who…
Chapter 16 The Role of Computers in Health Insurance Chapter outline I. Introduction II. Impact of Computers on Health Insurance III. Role of Health Insurance Portability and Accountability Act (HIPAA) in Electronic Transmissions…
Chapter 1 The Origins of Health Insurance Chapter outline I. What Is Insurance? II. History III. Metamorphosis of Medical Insurance IV. Key Health Insurance Issues A. How Can People Obtain Health Insurance? B. Access to Health…
Chapter 4 Types and Sources of Health Insurance Chapter Outline I. Types of Health Insurance A. Indemnity (Fee-for-Service) B. Managed Care II. Sources of Health Insurance A. Group Contract 1. Advantages 2. Disadvantages B. Individual Policies 1. Advantages 2. Disadvantages…
Chapter 7 Reimbursement Marion Gentul Chapter Outline PAYING FOR HEALTH CARE TYPES OF REIMBURSEMENT Insurance Types of Health Insurance Clinical Oversight Entitlements REIMBURSEMENT METHODOLOGIES FEE FOR SERVICE DISCOUNTED FEE FOR…
