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Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all health maintenance organizations (HMOs).
Founded in 1948, [26] Arkansas Blue Cross Blue Shield (ABCBS) [27] is an independent licensee of the Blue Cross Blue Shield Association, and the largest healthcare provider in the state. [28] It donated $1.98 million to The Walton College of Business toward founding its Robert L. Shoptaw Master of Healthcare Business Analytics Program. [ 29 ]
BlueCross BlueShield of South Carolina (BlueCross) is an independent licensee of the Blue Cross and Blue Shield Association. [1] BlueCross serves 21.5 million people through private business and government contracts. [2] BlueCross has several subsidiaries, two of which are affiliates licensed with the Blue Cross and Blue Shield Association.
In 1995, The Associated Group acquired Community Mutual Insurance, a provider of Blue Cross and Blue Shield insurance plans in Ohio with over 1.9 million policy holders), then set up Anthem Blue Cross and Blue Shield. [16] [17] In 1996, The Associated Group changed its name to Anthem Insurance Company. [17]
In the health insurance and the health care industries, FFS occurs if doctors and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service. [5] Payments are issued only after the services are provided. FFS is potentially inflationary by raising health care costs. [6]
[4]: 2 In the period between 1910 and 1940, early healthcare plans formed into two models: a capitated plan (essentially an HMO), and a plan which paid service providers, such as the Blue Cross and Blue Shield Plans. [4]: 2 One of the earliest examples is a 1910 "prepaid group plan" in Tacoma, Washington for lumber mills.
The Blue Cross Blue Shield Association (BCBSA) is a federation of 38 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans. [110]
[9] [10] Patients are typically not able to comparison shop for medical services based on price, as medical service providers do not typically disclose prices prior to service. [ 9 ] [ 10 ] [ 11 ] Government mandated critical care and government insurance programs like Medicare also impact the market pricing of U.S. health care.