This course will examine the history, structure and key elements of the two most significant payors in the American healthcare system, including their rules concerning eligibility and benefits, financing, provider enrollment, and provider reimbursement. The course will include a discussion of payment mechanisms (fee-for-service, managed care, and the various forms of value based payment), and a survey of the regulators responsible for oversight of the two systems and the mechanisms they use to ensure quality of care and address fraud, waste and abuse.
