Learning Outcomes

Compare employer-sponsored and self-funded health plans.

Describe the major features of group health plans regarding eligibility, portability, and required coverage.

Discuss provider payment under preferred provider organizations, health maintenance organizations, point-of-service plans, and indemnity plans.

Describe the two components of consumer-driven health plans and their effect on cash flow.

Compare and contrast health reimbursement accounts, health savings accounts, and flexible spending accounts.

List the five main parts of participation contracts and describe their purpose.

Describe the information needed to collect copayments and bill for surgical procedures under contracted plans.

Discuss the use of plan summary grids.

Describe the steps in the medical billing process that ensure correct preparation of private payer claims.

Discuss the key points in managing billing for capitated services.