Breaking Down Healthcare Payment Models: Fee-for-Service and Coding Systems Explained

In this episode of Delta Health Tech Innovators, Dr. Roupen dives deep into the critical topic of fee-for-service payment models in healthcare. Understanding these payment systems is crucial for entrepreneurs, startups, and anyone navigating the healthcare space. Dr. Rupen breaks down complex concepts like CPT codes, ICD codes, and the challenges with fee-for-service models that incentivize procedures over patient outcomes.

Whether you're a seasoned healthcare entrepreneur or just beginning your journey, this episode offers bite-sized insights to help you innovate and improve healthcare delivery. Tune in to learn how coding systems and reimbursement models impact the industry and how you can navigate these intricacies to drive patient-centered care.

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00:00 Introduction to Delta and Healthcare Innovation

00:38 Breaking Down Healthcare Concepts

01:13 Importance of Understanding Payment Models

01:41 Overview of Payment Models and Coding Systems

02:23 Explanation of Fee-For-Service (FFS) Payment Model

03:04 Fee-For-Service Analogy: Mechanic Shop

04:12 Incentives and Issues in Fee-For-Service Model

04:52 History of Coding Systems in Healthcare

05:32 CPT Codes: What Are They?

06:07 ICD-10 Codes and Their Role in Healthcare

06:54 HCPCS and NDC Codes Explained

07:33 How Reimbursement Works in Healthcare

08:12 Variables Affecting Reimbursement: Provider, Location, Payer

09:23 Challenges with Fee-For-Service Model

10:10 Example of Overuse of Services in Fee-For-Service

11:26 Incentives for Additional Procedures and Biopsies

12:41 Consequences of Fee-For-Service for Healthcare Costs

13:19 Transition to Value-Based Care

13:57 Importance of Understanding Payment Models for Entrepreneurs

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