A. Discuss the components of each of the following insurance plans: • indemnity plans • managed care plans • government-sponsored health plans (i.e., Medicare, Medicaid, and other government payers). • high-deductible health plans/healthcare savings accounts
B. Discuss the restrictions of each of the following insurance plans: • indemnity plans • managed care plans • government-sponsored health plans (i.e., Medicare, Medicaid, and other government payers). • high-deductible health plans/healthcare savings accounts
C. Discuss the reimbursement process for each of the following insurance plans: • indemnity plans • managed care plans • government-sponsored health plans (i.e., Medicaid and other government payers). • high-deductible health plans/healthcare savings accounts
D. Discuss the inpatient and outpatient reimbursement processes for Medicare, including DRGs (diagnostic related groups), APG (ambulatory patient groups), PPS (perspective payment systems), and RBRVS (resource-based relative value scale).
E. Discuss the history of Stark II, including its impact on the awareness of anti-kickback practices.
F. Analyze the impact of the Anti-Kickback Statute on healthcare providers who participated with Medicare. G. Discuss how third-party payment calculations, through contracted rates and prospective payment rates, affect healthcare reimbursement in healthcare organizations.
