Reimbursement Explained

This course will provide a foundation for understanding the common reimbursement systems in use today, Also 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.

Instructor: Rich Henriksen
Webinar Id: 801397

Duration: 90 Minutes

  • Recorded
  • Only for one participant ?
  • Price $179.
  • Corporate Recorded
  • Any number of participants ?
  • Price $379.

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 should you 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

Speaker 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. Rich has worked with over 70 different organizations, ranging from hospitals and clinics to third-party administrators, law firms, and internet-based companies. As a respected industry expert, he is well known for his unparalleled depth of knowledge in all aspects of healthcare coding, billing and reimbursement.

Rich received his Bachelor of Arts in biology from Luther College in Decorah, Iowa, and his Master of Arts in Healthcare Administration from The University of Iowa. He resides in Minneapolis, Minnesota where he leads the Nokomis Health team on their mission to set a new standard for medical claim review. Rich has previously trained staff at Optum, Prime Therapeutics, Definity Health, UCare Minnesota, TC Health, Essential Health, the American Association of Acupuncture and Oriental Medicine, and others. He has presented several times at SAS user conferences and other regional conferences.

An engaging instructor with an informal teaching style – making sessions enjoyable and easy to follow. Rich has taught this course to many professionals within the medical industry and incorporates feedback and suggestions from previous participants to evolve this incredibly insightful program. Rich allows time in the schedule for participants to ask questions.


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