HLTH-2030 Lecture Notes - Lecture 6: Preferred Provider Organization, Managed Care, Standard Cost Accounting

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Insurance companies, managed care organizations, blue cross blue shield, government. They set the amount that is reimbursed and the actual payment back to the provider of the organization. The patient + the provider + the one paying for services (3rd party) Payment made by third-party payers to the providers of services. Charge: fee set by provider & set the prices and the insurance companies would pay it and file a claim to. Rate: prices that are set by the third-party payers, and they decide how much to get paid. Fee schedule: listing of individual fees and services and how much you would get paid for each service. Current procedure terminology (ama) - updated 3-5 years and submit these to. Medicare and medicare bases them on value and that"s how they get reimbursed. International classification of diseases (who) - published every 10 years. Negotiate discounts with providers participating in the network. Still use some variation of that fee for service.

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