Webinar On Reimbursement Explained

Overview: Healthcare reimbursement systems can be complex and difficult to understand. Each 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 reimbursementTypical hospital contracting structures: per diem, per stay, carve outs, case rates, 
minimum/maximums, etc.Physician fee schedules and fee maximums, RBRVS, RVUs and capitationMajor payor types (Medicare, Medicaid, HMO, PPO, ACO, etc.) and how they reimburse providers
Who Will Benefit:Health Plan and Provider CFOsAnalystsProvider Contract ManagersClaim ExaminersReimbursement DirectorsPayment Integrity ManagersRevenue Managers