About This Chapter
Health Insurance & Reimbursement - Chapter Summary
Our helpful chapter covers health insurance and reimbursement in an easy-to-follow and user-friendly format. Review subjects such as the types of health insurance, insurance reimbursement methods and healthcare capitation at your own pace. You're welcome to complete the entire chapter or only the lessons you know you need to work on. We've also included quizzes with each lesson and a test at the end of the chapter as self-assessment tools so you know you're on the right track. This chapter is designed to help you achieve these goals:
- Discuss the key provisions of the Affordable Care and Patient Protection Act
- Outline the concept of health insurance
- Detail the types and roles of third-party payers
- Describe the impact third-party payment systems have on healthcare organizations
- Identify insurance reimbursement methods in health care
- Define healthcare capitation and its risk
- Understand the transition to value-based reimbursement
- Outline diagnosis codes and their uses
- Discuss the basics of the ICD-10-CM system
- Explain current procedural terminology (CPT) and its uses
1. The Affordable Care & Patient Protection Act: Key Provisions
In this lesson, you'll learn about the Affordable Care Act and how it impacts individuals with and without health insurance. You'll also learn what benefits it provides to those with health insurance.
2. Health Insurance: Types & Concept
Did you know that there are an estimated 1 billion health insurance claims filed each year? Learn more about the different types of health insurance that are available in the United States.
3. Third-Party Payers: Types, Roles & Regulations
Today's healthcare systems are facing challenges such as lower reimbursement for services. This lesson pinpoints the current third-party payment options, how reimbursement occurs, and regulatory concerns.
4. Impact of Third-Party Payment Systems on Healthcare Organizations
The U.S. healthcare system has several third-party payment systems that affect the finances of healthcare facilities. This lesson will define third-party payment systems and examine their effects on financial management of these facilities.
5. Insurance Reimbursement Methods in Health Care
This lesson launches us into the world of provider reimbursements from insurance carriers. We'll explore factors that may affect payments as well as the reimbursement methods physician practices and healthcare organizations use today.
6. Healthcare Capitation: Definition, Incentives & Risk
Capitation in healthcare is an alternative way for providers to be compensated for the care they give to their patients. This lesson will discuss the definition, incentives, and associated risks.
7. Transitioning to Value-Based Reimbursement
In this lesson, we'll define value-based reimbursement. You'll learn about the challenges in transitioning to this system and suggestions to manage change through the process.
8. What is a Diagnosis Code? - Definition & Uses
When you think of lifesaving medical care, groundbreaking scientific research and critical legislation writing, you don't think about the one subject that links them all: medical coding. In this lesson, learn the vital importance of diagnosis codes.
9. What is the ICD-10-CM System? - Basics & Uses
The ICD-10-CM system is used to code medical records in healthcare settings. This lesson will discuss the basics of the ICD-10-CM system as well as some of its uses.
10. Current Procedural Terminology (CPT): Definition & Uses
Current procedural terminology is a coding system that helps identify medical services and procedures. This lesson will discuss the definition and uses of current procedural terminology.
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Other chapters within the Health 305: Healthcare Finance & Budgeting course
- Introduction to Healthcare Finance
- Organizational Structure in Healthcare
- Healthcare Organizations & Services
- Financial Reporting in Healthcare
- Estimating Healthcare Costs
- Healthcare Financial Management
- Accounting & Income Statements in Healthcare
- Using Balance Sheets in Healthcare Finance
- Financial Assessment in Healthcare
- Healthcare Planning & Budgeting
- Project Costs & Evaluation in Healthcare
- Healthcare Staffing Needs & Forecasting
- Trends in Healthcare
- Required Assignment for Health 305