WAFL 8 Other Random Content

The iron triangle of healthcare includes

cost, access, quality

Healthcare system has

patients, providers, insurers, government

True or False: ICD codes are codes implemented and used by the US only

FALSE

ICD 10 codes are used for

classification of disease, injury, health encounters as well as to treat a diagnosis and/or include a patient's medical diagnosis

True or False: CPT charges can be inconsistent among payers based on private or public insurance policies?

FALSE

Timed codes are used for charging

Treatment

A PT's minutes are counted based on

Units of Service

True or False: Fee for Service is a fixed rate of payment to care for a patient

FALSE

How does the healthcare market differ from a regular market?

1) number of parties involved in transaction

2) uncertainty of outcomes of care

3) asymmetry of information

4) difficulty monitoring quality

5) barriers to market entry

What are the basic elements on a PT claim for?

ICD-10 codes (primary diagnosis), CPT codes (procedure codes), Overall charge amount

What are the two types of CPT codes?

un-timed (eval) and timed (treatment)

What is the overall charge amount?

sum of timed and untimed codes

True or False: what is billed is not equal to what is collected/received from the insurer

TRUE

Describe the Fee For Service Model

providers are paid a fixed amount per code or a percentage of the billed price proper code depending on the insurer. The more codes billed, the more the provider is paid

What are cons of the FFS model?

could lead to misalignment of incentives

Describe the Capitation model

fixed rate of payment to care for a patient, no longer a situation of the more you do the more you get paid.

Describe the bundled/episode-based payments

payment is fixed, reimbursement is based on a fixed length of stay or episode of care that can occur across settings/continuum

Describe the Value Based Reimbursement model

shifts payment from solely based on volume of care to outcomes of care

What are the results of changing and varied payment mechanisms?

1) providers can get paid in a variety of ways

2) more you do/more you get is less common

3) shifting to more value based models

4) risk is shifted from payer to provider