Principles_of_Healthcare_Reimbursement_in_the_U_1_

Principles_of_Healthcare_Reimbursement_in_the_U_1_ -...

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Principles of Healthcare  Reimbursement  
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Compensation for Healthcare Reimbursement – the compensation or  repayment for healthcare services Third party payers First party Second party Characteristics of Reimbursement  methodologies Unit of payment Time orientation Degree of risk
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Types of Healthcare  Reimbursement  Methodologies Fee-for-service Self-pay Retrospective payment Fee schedules Episode-of-care Capitation Global payments Prospective payment
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Historical Timeline 1860 – First health insurance policy by the Franklin Health Assurance Company  of Massachusetts was the first commercial insurance company in the United  States to provide health care coverage for injuries that did not result in death 1880 – Sixty additional insurance companies offer healthcare policies.  These  usually covered loss of income and a limited number of illnesses (typhoid, small  pox, etc.) 1920 – the first contracts between employers and local hospitals and physicians  were developed.  Participating hospitals and physicians performed specified  medical services for a predetermined monthly or yearly fee.  These prepaid  health plans were the forerunner of today’s managed care plans 1929 – Justin Kimball, an official at Baylor University in Dallas, introduced a plan  to guarantee schoolteachers 21 days of hospital care for $6 a year.  Other  groups of employees in Dallas joined and this is generally considered the first  Blue Cross plan
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Historical Timeline 1939 – The Blue Cross symbol was officially adopted by a commission of the  AHA as the national emblem for plans that met certain guidelines 1939 – The first Blue Shield plan was founded in California.  The Blue Shield  concept grew out of the lumber and mining camps of the Pacific Northwest.   Employers wanted to provide medical care for their workers so they paid  monthly fees to medical service bureaus composed of groups of physicians 1945 – Harry Truman was the first U.S. President to support a plan for universal  comprehensive national health insurance including private insurance for those  who could not afford it and public welfare services for the poor.  This legislation  was not passed into law
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Historical Timeline 1950 – Insurance companies began offering major medical insurance which  provided coverage for catastrophic or prolonged illnesses and injuries.  Most of  these programs incorporate law deductible and lifetime maximum amounts 1965 – Title 18 and 19 of the Social Security Act were passed – established  Medicare and Medicaid 1977 – The Health Care Financing Administration of HCFA was formed within 
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This note was uploaded on 05/09/2011 for the course HCA 580 taught by Professor Hazelwood during the Spring '11 term at University of Louisiana at Lafayette.

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Principles_of_Healthcare_Reimbursement_in_the_U_1_ -...

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