COMPREHENSIVE INTRODUCTION TO CASE MANAGEMENT-SECTION 2-FINANCIAL REIMBURSEMENT SYSTEMS

Course overview

OBJECTIVES 1. Define and explain: Length of Stay DRG Outlier APC OPPS OASIS IRF-PAI, RICs, and CMGs MDS Medicare and Medicaid 2. Discuss the differences / similarities between HMOs and PPOs 3. Describe Managed Care and it's stages of development / maturation 4. Explain and discuss: Integrated Delivery Systems Worker's Compensation benefit plans Automobile Insurance Disability Insurance Long-Term Care Insurance OUTLINE A. ORIGINS OF THE PROSPECTIVE PAYMENT SYSTEM: AN OVERVIEW B. USE OF DOCUMENTATION C. DRGs D. USE OF DRGs TODAY E. APCs: MEDICARE'S OUTPATIENT PROSPECTIVE PAYMENT SYSTEM F. HOME CARE PROSPECTIVE PAYMENT SYSTEM G. INPATIENT REHABILITATION FACILITY PROPECTIVE PAYMENT SYSTEM H. LONG-TERM CARE REIMBURSEMENT (SKILLED NURSING FACILITY) I. THIRD-PARTY PAYERS/MANAGED CARE ORGANIZATIONS J. MANAGED CARE AND ITS STAGES OF DEVELOPMENT/MATURATION K. INTEGRATED DELIVERY SYSTEMS AS A RESPONSE TO MANAGED CARE L. OTHER HEALTH BENEFIT PLANS M. PROACTIVE TACTICS TO COUNTERACT THE EFFECTS OF MANAGED CARE