Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.1.

Slides:

Advertisements

Similar presentations

Medical Insurance Chapter 18 ICBS 120.

Advertisements

Managing Resources Responsibly Chapter 3. Factors Affecting Costs of Health Care.

Instructor’s Name Semester, 200_

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.

Copyright © 2006 Thomson Delmar Learning. ALL RIGHTS RESERVED. 1 PowerPoint ® Presentation for Dental Office Management Module: Financial Management.

Copyright © 2008 Delmar Learning. All rights reserved. Chapter 3 Managed Health Care.

Chapter 9 Managed Care and Managed Care Organizations (MCOs)

Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 6 Health Care Economics.

1 Introduction to the Medical Billing Cycle Chapter One lecture 2 OT 232.

CHAPTER © 2012 The McGraw-Hill Companies, Inc. All rights reserved. 1 Introduction to the Medical Billing Cycle.

1.03 Healthcare Finances Understand healthcare agencies, finances, and trends Healthcare Finances Government Finances Private Finances 2.

Slide 1 Chapter The Health Care System. Slide 2 Health Care Delivery, Past and Present.

Understanding Your Options Sarah Hartshorn Rob Bachman Jeff Jensen An Introduction to Health Insurance.

Slide 1 Copyright © Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing.

Copyright ©2004 Pearson Education, Inc. All rights reserved. Chapter 11 Health and Disability Insurance.

 Indemnity or Fee-for-Service coverage- -allow you go to the doctor of your choice and pay for services at the time of the visit. -The amount that your.

Dynamics of Care in Society Health Care Economics 1.

Healthcare Finances HS II Unit 1.03.

CHAPTER © 2012 The McGraw-Hill Companies, Inc. All rights reserved. 1 Introduction to the Medical Billing Cycle.

Component 1: Introduction to Health Care and Public Health in the U.S. 1.5: Unit 5: Financing Health Care (Part 2) 1.5b: Reimbursement Methodologies and.

1.3 Health Care Plans (Continued) 1-14 Managed care offers a more restricted choice of providers and treatments in exchange for lower premiums, deductibles,

1 Fourth: Health Care Plans: 1. 2 The Economics of Health Care: Price rationing occurs because buyers base purchasing decisions on the relative quality.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 19: Health Care Economics.

U.S. Healthcare Policy. Project 4: One page summary of the project including comments on the student's contributions. Describe how the project contributed.

Chapter 2 Health Care Systems.

Al H 116/Rad T 216 Financial Aspects of Hospital Management.

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Reading Chapter 3 For Unit 2’s readings, you will read Chapter 3: “An Introduction to Health.

Paying for Health Care Insurance Medicare and Medicaid Managed Care Workers’ Compensation Military Health Care.

INSURANCE & COSTS HEALTH CARE SERVICES. MEDICAL CARE (INSURANCE) HEALTH MAINTANCE ORGANIZATION (HMO) – A TYPE OF GROUP HEALTH INSURANCE PLAN – MEDICAL.

Managed Care Organizations. Managed Care Continuum Use of Managed Care Techniques Less More Traditional Indemnity Health Plan Traditional with Cost Containment.

Health Insurance Why the Need? Protects consumers from the high costs of medical bills due to illness or injury & against the law not to have it.

Copyright © 2008 Delmar. All rights reserved. Chapter 7 Health Care Organization and Financing.

Copyright ©2004 Pearson Education, Inc. All rights reserved. Chapter 11 Health and Disability Insurance.

Copyright © 2008 Delmar Learning. All rights reserved. Chapter 14 Medicare.

Health Care Costs. How we pay for health care: Private pay Private pay Group health insurance Group health insurance Government sponsored plans Government.

Financing Health Care United States Healthcare. PRIVATE INSURANCE Pays for all or part of a person’s health care Pays for all or part of a person’s health.

2 Understanding Managed Care: Insurance Plans.

Comprehensive Health Insurance Billing, Coding, and Reimbursement Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights.

Chapter 6 Home Health. Copyright © 2005 by Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Number of Medicare-Certified Home Health Agencies,

Chapter 14 Financing. Copyright © 2005 by Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Personal Health Care Expenditures, 1965 Physicians 20% Nursing.

Chapter 7 Hospice. Copyright © 2005 by Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Number of Hospice Programs in the United States 1 1,545 1,529 1,874.

Outcomes of Managed Care. MCOs and Controlling Costs MCOs do so by controlling 1)MDs 2)Patients 3)Health Care Institutions.

How does it work?.  Compare the basic principles of at least four different insurance plans.  Apply the concepts of insurance deductible, co-insurance,

Component 1: Introduction to Health Care and Public Health in the U.S. 1.4: Unit 4: Financing Health Care (Part 1) 1.4 c: Insurance and Third-Party Payers.

McGraw-Hill/Irwin Copyright © 2008 by The McGraw-Hill Companies, Inc. All rights reserved. CHAPTER 10 GOVERNMENT AND THE MARKET FOR HEALTH CARE.

1.03 Healthcare Finances. Health Insurance Plans Premium-The periodic amount paid to an insurance company for healthcare or prescription drugs Deductible-Amount.

1.03 Healthcare Finances Understand healthcare agencies, finances, and trends Healthcare Finances Government Finances Private Finances 2.

Copyright ©2012 Delmar, Cengage Learning. All rights reserved. Chapter 14 Health Insurance.

Health Insurance Plans 2.4 Cost is a major concern Health care is over 15% of the gross national product Without insurance the cost of an illness can become.

Unit C: Health Care Systems Part 4 Health Team Relations.

The Health of the Nation. Judging the Health of a Nation Quality of its doctors and medical institutions Doctors from all over the world come to the U.S.

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.1.

Chapter discussion questions Health care plans.

HEALTH INSURANCE PLANS. BACKGROUND INFO Cost is a major concern Health care is over 15% of gross national product Without insurance, the cost of an illness.

Health Insurance Question: Why should I have health insurance? The cost of health care has risen drastically over the past few decades. If you do not have.

Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

Unit 8 Business of Caring. Chapter 22 Controlling Health Care Costs.

Financial Issues Chapter 14. Financial Issues Financial issues have a substantial influence on health care and pharmacy practice. In 1985 the average.

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Practice.

The Blues Plans, Private Insurance, and Managed Care Plans

DISCUSS THE BASIC PRINCIPLES OF DIFFERENT INSURANCE PLANS

Chapter 3 Managed Health Care.

Introduction to the Revenue Cycle

Chapter 5 Nursing Homes.

MAA 102_Intro. Billing & Coding

GOVERNMENT AND THE MARKET FOR HEALTH CARE

Answers to insurance wkst

MAA 102_Intro. Billing & Coding

Presentation transcript:

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.1

2

3

4 Paying for Health Care Rising costs Need to control costs Fee-for-service Premiums New ways of paying for health care

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Managed Care Specific built-in cost controls Profit Prepaid plans Negotiated fees

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Managed Care Systems Health Maintenance Organization (HMO) Exclusive Provider Organization (EPO) Preferred Provider Organization (PPO)

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Restriction of Usage Primary care providers (PCP) Gatekeepers Preauthorization

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Government Programs Medicare Medicaid Diagnostic Related Groups (DRGs) Reimbursement Minimum standards of care

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Controlling Organizational Costs Resources required –Financing –Technology and supplies –Facilities –Personnel

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Resources Required

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Costs Account receivable Account payable Cost of money

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Impacting Costs Ask –How can I help to reduce unnecessary costs? Personal efficiency Focusing on the job

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Impacting Costs Careful use of supplies and equipment Billing and coding correctly Maintaining inventory Educating patients Being willing to cross-train

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Personal Efficiency Use problem-solving process Assume responsibility Don’t just let life pass you by Don’t become sidetracked

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Personal Efficiency Expect setbacks Eliminate unimportant time wasters Communicate clearly and honestly Look at your life as a whole

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Acting With Thought What are the facts? What is the best course of action? What is the right thing to do? What is the probable impact of my actions?