If the Oconee Health Plan reimburses its specialty care physicians (SCPs) under a typical retainer method, then Oconee pays SCPs:
One reimbursement method that health plans can use for hospitals is the ambulatory payment classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs) method of reimbursement.However, when comparing APCs and DRGs, one of the primary differences between the two methods is that only the APC method:
Four types of APCs are ancillary APCs, medical APCs, significant procedure APCs, and surgical APCs. An example of a type of APC known as:
The Gladspell HMO has contracted with the Ellysium Hospital to provide subacute care to its plan members. Gladspell pays Ellysium by using a per diem reimbursement method.The per diem reimbursement method will require Gladspell to pay Ellysium a:
The Gladspell HMO has contracted with the Ellysium Hospital to provide subacute care to its plan members. Gladspell pays Ellysium by using a per diem reimbursement method.If Gladspell's per diem contract with Ellysium is typical, then the per diem payment will cover such medical costs as:
By definition, a measure of the extent to which a health plan member can obtain necessary medical services in a timely manner is known as:
