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reimbursement method

Laura Franco Mop 130

QuestionAnswer
Ambulatory Payment Classification (APC) Utilized by Medicare and other carriers for outpatient facility reimbursement. Facilities are paid based on a fixed fee based on procedure(s) provided by the facility.
Capitation Generally utilized by managed care plans. Methodology is based on a monthly per-member-per-month (PMPM) fee for each enrolled member.
Case Rate Set rate paid to the facility for the entire case
Contract Rate Set rate as agreed upon in a preagreed-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 schedule 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 physician time, skill, practice overhead, and malpractice.
Created by: frla5938
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