Physician Assistant Professional Practice UNIT 1., Study Guides, Projects, Research of Health sciences

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3/15/25, 4:37 AM about:blank Physician Assistant Professional Practice UNIT 1 Week 1 Insurance & Payers 0& Ro 8 7 Healthcare includes: payers, individuals, organizations to manage benefits & determine how much would be paid to whom system ayer reani ee ai sets defined benefits, cost sharing, and coverage limits to control spending on healthcare services TERM DEFINITION TERM DEFINITION Payer sets defined benefits cost sharing, and coverage Cost > Toprovides the expense incurred limits to conto! spending on healthcare services to deliver beath care services to * patients A P > Topayers: the amount they pay to 5 oi providers for services rendered > Topatens: the amount they pay out-of-pocket for health care Defined What medical goods and services are covered CCharge or price The amount asked by a provider fora health benefits (wil be paid for) care good of service, which appears on a medical bill Coverage ‘Maximum amounts pid by the insurer fora type Reimbursement payment made by a third party to 8 limits ofbenefit Provider for services. Three types: Cost sharing Amount of money a member of a health - insurance plan mus py ot of pocket reach Fear [Amount reach seve covered benefit. Types of cost-sharing: service Perdiem |For each day in the hospital Copayment- [Coinsurance | Deducible- fixed amount | - percentage fixed amount Diagnosis- | DRGs for each episode of ofmoney per |oftotal cost | of money related hospitalization benefit ofbenefit | paid before toups any coverage , wane Capitation |For each patent under care lying the terms above; examples below 70k A paints insurane that ists blood draws as defined benefit. The costo the patient for this blood draw i Sores 0 the copayment they have to pay when their blood is drawn costa The cost to insurance for a PA interpretation ofa radiograph is $25. The cost tothe PA is 1-3 minutes of labor interpreting the radiograph. The PA is reimbursed $25 for interpreting the radiograph and documenting their findings in the electronic health record (EHR). This is a fe-for-service reimbursement, one payment for one service delivered. (more examples on PAPP page 14