This courses focuses on the history, rationale, and methodology of the systems used by third-party payers to determine the reimbursement health care providers will receive. Reimbursement concepts include fee-for-service, managed care, capitation systems, Diagnosis-Related Groups (DRGs), Resource Based Relative Value Scale (RBRVS), Ambulatory Payment Classifications (APCs), and related concepts. The use of the charge description master (charge master) in reimbursement will be discussed. The importance of compliance with regulations and the related issues of fraud and abuse will also be addressed.
Not Offered This Semester