Managed Care Reimbursement Methodologies

This course discusses financial management, the central thread that interconnects the various elements of managed care. It explains various reimbursement methodologies commonly used in managed care and the underlying assumptions and risk management funding mechanisms that are responsible for these reimbursement methodologies. This course describes basic and advanced reimbursement methodologies used for hospital services and basic reimbursement methodologies used for physicians and other professionals.

Estimated course completion time: 1 hour and 15 minutes

Learning Objectives:

After this program, you’ll be able to..

• Recognize how a typical premium dollar is allocated
• Identify the role of risk in managed care
• Identify some common cost control measures used in managed care
• List the basic reimbursement methodologies used for hospital services
• Recognize the advantages and disadvantages of these reimbursement methodologies
• Define carve-outs, inpatient stop-loss, short-stay stop-loss, and withhold pools
• List the advanced reimbursement methodologies used for hospital services
• Identify coordination of benefits, managed Medicare organizations, and TRICARE
• Identify the basic reimbursement methodologies used for physicians
• Recognize the advantages and disadvantages of these reimbursement methodologies
• List some popular capitation-based cost-control incentives

General Program Information