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Health insurance and reimbursement methodologies are some of the basic foundations of understanding health care finance. Health care administrators must have a basic understanding of these areas to successfully run their respective departments and/or organizations. Interestingly enough, most consumers have no concept
of how their benefits are designed, implemented, and paid for. Understanding health insurance from a financial
perspective is one aspect to review. Aligning the insurance with networks, co-pays, co-insurance, and deductibles from a structural perspective and connecting the dots with providers and payors complicates
matters even further. Hopefully, this section will clarify these complexities.
Module Objectives
At the end of this module students will be able to:
Review the history of setting charges. (CO1, CO4)
Define the various methods of setting charges.(CO2, CO4)
Describe the impact of cost shifting. (CO1)
Review methods of reimbursement to providers. C01,C04)
Sample Solution
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