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Reimbursment Methodo
| Question | Answer |
|---|---|
| Ambulatory Payment Classification (APC) | Utilized by Medicare and ither carriers for outpatient facility reimbursement. Facilities are paid based on fixed fee based on procedures provided by the facility |
| Capitation | Generally utilized by managed car eplans. Methodologies is based on monthly pre-member-per-month )(PMPM) fee fr each enrolled member |
| Case Rate | set rate paid to facility for the entire case |
| Contract Rate | set rate as agreed upon in prearranged-upon contract |
| Diagnosis Related Group (DRG) | inpatient reimbursement methodology where the facility is paid fixed fee for the patient's Diagnosis or condition |
| Fee-For-Service | Fee scheduled for each service medically necessary and provided by facility |
| Fee Schedule | Schedule for allowances for each service provided by the facility that is medically necessary |
| Flat Rate | Reimbursement methodology is based on a set rate per each admission, regardless of total charges |
| Per Diem | set rate per day |
| Resource-Based Relative Value Study | Each code/procedure is assigned a set value that is comprised of multiple components, such as a physicians time, skill, practice overhead, and malpractice ` |
| Usual, Customary , and Reasonable (UCR) | reimbursement is based on usual fee, customary fee, and reasonable fee, which ever is less |
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