HSC 3243 Lecture Notes - Lecture 30: Medicare Advantage, Prescription Drug, Medical Necessity
Document Summary
Payer sources: third-party payers: payment for services by an entity other than the patient or their family, two types: private insurance and government programs. Payer source: private insurance: typically funded by contribution to a plan through an employer or it can be purchased individually, ot must be aware of the limitations and restrictions that may impose services. Payer sources: government program- worker"s compensation: a state program that pays for the care of workers who have injuries or illness as a result of a work-related injury. Patient driven payment model [pdpm]: a current system for medicare services for. Snf: the goal is quality over volume-based care. Payment is based on patient characteristics and diagnoses and not on the amount of therapy services delivered. Payment by setting: home health care: outcome and assessment information set [oasis]: screening tool in home. Health settings that evaluates the patient status and monitors outcomes for the quality of patient care.
