Reimbursement Explained

MentorHealth
Date: Thursday September 26, 2019
Time:

10:00 AM PDT | 01:00 PM EDT

Duration: 90 Minutes
Instructor: Michael Stearns
Webinar Id: 801790
37 Days Left To Register

 Live 

$139.
One Attendee
$299.
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Recorded

$179.
One Attendee
$379.
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Live + Recorded
$269 $318  
One Attendee
Live + Recorded
$599 $678  
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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.

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
Michael Stearns, MD, CPC, CFPC, is a physician informaticist, certified professional coder (CPC), certified family practice coder (CFPC). He is the CEO and Founder of Apollo HIT, LLC, an Austin-based company that provides consulting services in the areas of healthcare information technology and compliance. His company assists organizations with meeting their documentation, coding, EHR optimization and program goals, including their performance in the Merit-based Incentive Payment System and Alternative Payment Models.

During his career Dr. Stearns has received several awards for teaching and contributions to patient safety and patient privacy initiatives. He played a central role in the design and development of vocabularies at the National Institutes of Health (NIH) and provided a leadership to the development of the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). He has served in a leadership capacity for two leading EHR vendors and as an advisor to several emerging HIT organizations.

He is a cofounder and lecturer at the University of Texas at Austin Health Information Technology Certificate Program, a nationally recognized model for HIT workforce development. He has been invited to testify in Washington, D.C. before federally sponsored HIT policy and standards organizations on five separate occasions. He served as the founding board president of the Texas eHealth Alliance, an organization that provides stakeholder input related to health information technology policy matters to state legislators. He is also an accomplished author and lecturer on a range of health care quality, health information technology, coding/compliance and quality-based performance initiatives.


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