The CAPC Payment Accelerator: A Joint Virtual Workshop for Home-Based Care Teams-CAPC Payment Glossary

CAPC Payment Glossary

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The document is a payment glossary of terms provided by the Center to Advance Palliative Care (CAPC), an organization focused on improving the availability and quality of palliative care services. CAPC provides various forms of assistance such as training, tools, and technical support to healthcare professionals to develop and sustain palliative care programs. CAPC is funded by memberships and various philanthropic contributions, and it operates with technical assistance from the Icahn School of Medicine at Mount Sinai in New York City.<br /><br />This glossary aims to clarify numerous payment-related terminologies used in healthcare, especially in the context of palliative care. It includes detailed definitions of various concepts and models used in the payment and billing processes within the healthcare system, such as:<br /><br />1. <strong>Accountable Care Organization (ACO)</strong>: A group of medical providers that take accountability for the overall quality and cost of healthcare services for a set group of patients.<br />2. <strong>Actuary and Actuarial Models</strong>: Professionals and models that predict healthcare costs based on historical data.<br />3. <strong>Advanced Alternative Payment Models (APMs)</strong>: Payment models that meet specific criteria under the Medicare Access and CHIP Reauthorization Act (MACRA) for avoiding certain penalties and receiving bonuses.<br />4. <strong>Bundled Payment</strong>: A payment method where multiple services are combined into a single payment.<br />5. <strong>Capitation</strong>: A payment model where providers receive a fixed amount per person for providing a broad range of services.<br />6. <strong>Care Management</strong>: Efforts to coordinate patient care effectively, reducing gaps and preventing excessive or inappropriate service utilization.<br />7. <strong>Medicaid and Medicare</strong>: Public health insurance programs with distinct eligibility requirements but both aimed at providing financial assistance for healthcare.<br />8. <strong>Medicare Parts A, B, C, and D</strong>: Different components of Medicare covering facility services, professional services, private insurance plans, and medications, respectively.<br /><br />The glossary is comprehensive and includes entries from A to W, describing various other concepts like Merit-based Incentive Payment System (MIPS), Shared Savings, Risk Adjustment, and Value-based Payment. This information is aimed at healthcare administrators and providers to better understand and navigate the complexity of healthcare payment systems.

Keywords

palliative care

payment glossary

healthcare terms

CAPC

Accountable Care Organization

Advanced Alternative Payment Models

Bundled Payment

Care Management

Medicaid and Medicare

Value-based Payment