Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Billing Process of Various Health Care Enterprises
Slide content:Managed Care Reimbursement Reimbursement Contract with providers to limit fees Fee-for-service: Discounted fee schedules Episode-of-care: Prospective payment Patient utilization control through Financial incentives to use network resources Offer lower in-network costs Increase out-of-pocket expenses for non-network use 20
Slide notes:Finally, in managed care reimbursement, Managed Care Organizations, or MCOs , contract with providers to limit fees. The MCO may use a fee-for-service methodology in which payments are made according to a discounted fee schedule, or an MCO may use an episode-of-care reimbursement, such as a prospective or global payment. MCOs provide an incentive to patients to use resources effectively, by either lowering in-network costs, or by raising costs for non-network care. 20