Course Summary
Learn the fundamentals of reimbursement models in healthcare and gain the skills to design and implement them in your organization.Key Learning Points
- Understand the different types of reimbursement models and their impact on healthcare organizations.
- Learn how to design and implement effective reimbursement models.
- Explore case studies and real-world examples to deepen your understanding of reimbursement models.
Related Topics for further study
Learning Outcomes
- Design effective reimbursement models for healthcare organizations.
- Analyze the financial impact of different reimbursement models.
- Evaluate the effectiveness of existing reimbursement models and recommend improvements.
Prerequisites or good to have knowledge before taking this course
- Basic understanding of healthcare industry.
- Basic knowledge of financial analysis.
Course Difficulty Level
IntermediateCourse Format
- Self-paced
- Online
- Video lectures
- Case studies
Similar Courses
- Healthcare Finance
- Healthcare Management: Strategy and Innovation
Related Education Paths
Notable People in This Field
- Dr. David Nash
- Dr. Michael Porter
Related Books
Description
This course is designed to help you build high-level knowledge of the current medical coding and payment mechanisms of most U.S. healthcare services, referred to as fee-for-service. You will explore why the fee-for-service model has contributed to higher costs in the U.S. healthcare system without clearly improving health outcomes. You will examine the importance of coding to reflect chronic conditions and other diagnoses accurately and how value-based care and payments utilize these measures and data. As you learn about a model to replace fee-for-service, you’ll encounter a range of payment options considered to be value-based that utilize a framework from the Health Care Payment Learning and Action Network (HCP-LAN). To build on those options, you will learn how risk-adjustment, quality scores, and patient satisfaction measures are critical parts of value-based care and payment contracts. In the summative assignment, you will demonstrate your knowledge by comparing fee-for-service and value-based contracts, using specific examples to explain and justify the importance of documentation and coding, and identifying ways that risk-adjustment and patient satisfaction are incorporated into value-based care contracts.
Knowledge
- Explain fee-for-service medical coding and payment mechanisms and why fee-for-service leads to higher costs without clearly improving outcomes.
- Describe the range of value-based payment options from the HCP-LAN Alternative Payment Model framework.
- Describe the importance of risk adjustment, quality scores, and patient satisfaction measures in value-based care contracts.
Outline
- From Fee-For-Service to Value-Based Payments
- If this is your first VBC course, please watch our Welcome.
- How This Course Works
- Level Set
- Current and Historical Reimbursement Models
- CPT (Current Procedural Terminology) Codes
- ICD (International Classification of Disease) Codes
- Fee-For-Service: Volume Not Value
- Population Costs and Value: Think Like an Insurance Company
- Moving to Value
- Examples of Current Value-Based Arrangements in Traditional Medicare
- Explore the Optional Resources for Module 1
- References for Module 1
- Module 1 Quiz
- Quality and Risk Adjustment in Value-Based Payments
- The History and Purpose of Risk Adjustment
- The Role of Risk Adjustment in Value-Based Care and Payment Models
- Medicare Risk Adjustment (MRA) Payment Model
- Risk Adjustment Is a Collaborative Effort
- Measuring and Paying for Quality
- Medicare Star Rating Program Framework
- Consumer Assessment of Healthcare Providers and Systems
- HEDIS
- Patient Safety Measures
- Comprehensive Population-Based Payment Models from HCP-LAN
- A Value-Based Payment Spectrum
- Explore the Optional Resources for Module 2
- Module 2 Quiz
- Course Project: Making This My Own
Summary of User Reviews
This course on reimbursement models received positive reviews from users. It covers the latest trends in healthcare reimbursement and is taught by industry experts. One key aspect that many users thought was good is the practical application of the concepts learned in the course.Pros from User Reviews
- Taught by industry experts
- Covers latest trends in healthcare reimbursement
- Practical application of concepts learned in the course
- Easy to follow lectures
- Engaging assignments
Cons from User Reviews
- Limited interaction with instructors
- Some technical issues with the platform
- Course material may be too basic for advanced learners
- Not enough focus on specific reimbursement models
- Does not cover international healthcare reimbursement practices
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