This webinar will help understand DRG system used as the structure for reimbursement under Medicare/Medicaid programs including review of DRG relative weights, case mix index, length of stay, medical record coding, managed care contracting, bundled payments and strategies to control cost and length of stay in bundled payment environment.
Today, acute care settings must work with each of these reimbursement methods, creating some confusion as well as challenges for all concerned.
This program will provide a foundation of knowledge and understanding of the DRG system used as the structure for reimbursement under the Medicare and Medicaid programs. We will review the DRG relative weights, case mix index and expected lengths of stay. You will learn how to do Medical record coding in the context of how hospitals get reimbursed. How to do managed care and managed care contracting as well as the various managed care products currently on the market.
The program will conclude with a discussion on bundled payments and what case management professionals need to know in order to assist their organizations in controlling cost and length of stay in a bundled payment environment where patients may access care and use resources at any touch point on the continuum.
Why Should You Attend:
The area of healthcare reimbursement has changed significantly since the introduction of the Prospective Payment System and its diagnosis related groups (DRGs) around 1985. DRGs were a reimbursement scheme aimed at controlling cost and length of stay. Because cost continued to rise, managed care organizations offered healthcare benefits at lower cost and began to proliferate. Most recently, the Centers for Medicare and Medicaid Services (CMS) has begun experimenting with bundled payments, a take-off on the earlier capitation methods.Today, acute care settings must work with each of these reimbursement methods, creating some confusion as well as challenges for all concerned.
This program will provide a foundation of knowledge and understanding of the DRG system used as the structure for reimbursement under the Medicare and Medicaid programs. We will review the DRG relative weights, case mix index and expected lengths of stay. You will learn how to do Medical record coding in the context of how hospitals get reimbursed. How to do managed care and managed care contracting as well as the various managed care products currently on the market.
The program will conclude with a discussion on bundled payments and what case management professionals need to know in order to assist their organizations in controlling cost and length of stay in a bundled payment environment where patients may access care and use resources at any touch point on the continuum.
Areas Covered in the Webinar:
- Diagnosis related groups (DRG)
- Medicare
- Medicaid
- Managed care definition
- Managed care contracting
- Managed care products
- Bundled payments - Mandatory and voluntary
- Managing cost across the continuum
- What case managers need to know while educating patients
Who Will Benefit:
- Director of Case Management
- RN Case Managers
- Director of Finance
- Director of Social Work
- Social Workers
- Hospitalists
- Physician Advisors
- Directors of Nursing
Speaker
Toni CestaCourse Provider
Toni Cesta,
