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Study sets matching "principles of healthcare reimbursement"

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Study sets matching "principles of healthcare reimbursement"

85 terms
Principles of Healthcare Reimbursement
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
85 terms
Principles of Healthcare Reimbursement
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
29 terms
Principles of Healthcare Reimbursement 8
What is the average of the sum of the…
What is the general term for software…
The federal government is determined t…
What is the term for an index based on…
Case mix index
Grouper
Conversion Factor
GPCI
What is the average of the sum of the…
Case mix index
What is the general term for software…
Grouper
85 terms
Principles of Healthcare Reimbursement
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
29 terms
Principles of Healthcare Reimbursement 8
What is the average of the sum of the…
What is the general term for software…
The federal government is determined t…
What is the term for an index based on…
Case mix index
Grouper
Conversion Factor
GPCI
What is the average of the sum of the…
Case mix index
What is the general term for software…
Grouper
26 terms
Principles of Healthcare Reimbursement Chapter 3
Voluntary Healthcare Insurance
Voluntary Healthcare Insurance (cont.)
Types of Voluntary Healthcare Insurance
Confusing Terminology
Denotes healthcare insurance that is purchased... Related to emp…
Indemnity health insurance (Retrospective fee-for-service)... Gu…
Umbrella term for 2 major categories, 3 classifications, and…
"Private" used two ways... Synonym for commercial insurance... Purc…
Voluntary Healthcare Insurance
Denotes healthcare insurance that is purchased... Related to emp…
Voluntary Healthcare Insurance (cont.)
Indemnity health insurance (Retrospective fee-for-service)... Gu…
103 terms
Principles in Healthcare Reimbursement
Assignment of benefits
Coinsurance
Deductible
Diagnoses
authorization by policyholder that allows a health plan to pa…
the portion of charges that an insured person must pay for he…
An amount of money that an insured person must pay annually b…
a physician's opinion of the nature of patients' illness or i…
Assignment of benefits
authorization by policyholder that allows a health plan to pa…
Coinsurance
the portion of charges that an insured person must pay for he…
85 terms
Principles of Healthcare Reimbursement
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
85 terms
Principles of Healthcare Reimbursement
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
68 terms
Principles of Healthcare Reimbursement ch 10keeper
P4P
VBP
P4P (or PFP) systems
VBP and P4P Systems
started by large private employers and coalitions seeking to…
implemented by federal reimbursement systems
Any type of providers' payment system that is based on perfor…
Spur interest in redesigning healthcare to focus on quality... -…
P4P
started by large private employers and coalitions seeking to…
VBP
implemented by federal reimbursement systems
94 terms
Principles of Healthcare Reimbursement Final
Which of the following points is a gui…
What is the average of the sum of the…
The MS-DRG payment includes reimbursem…
Select the highest level of the IPPS h…
Incentive for cost control because hospitals retain profits o…
Case mix index
Progress notes
Major diagnostic category
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
16 terms
Principles of Healthcare Reimbursement Chapter 7
RBRVS Formula
Resource-Based Relative Value Scale
Resource-Based Relative Value Scale pe…
Geographic Practice Cost Indices
[(WORK RVU) (WORK GPCI) + (PE RVU) (PE GPCI) + (MP RVU) (MP G…
Payment system that reimburses physicians' practice expenses…
Controlled Fee-for-Service System Based on CMS's Estimation o…
Geographic Practice Cost Index (GPCI) An adjustment that acco…
RBRVS Formula
[(WORK RVU) (WORK GPCI) + (PE RVU) (PE GPCI) + (MP RVU) (MP G…
Resource-Based Relative Value Scale
Payment system that reimburses physicians' practice expenses…
85 terms
Principles of Healthcare Reimbursement
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
85 terms
Principles of Healthcare Reimbursement
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
23 terms
Principles of Healthcare Reimbursement chapter 9
Accounts receivable
Charge capture
Copayment
Deductible
Accounts Receivable (A/R) Department -A department in a healt…
Revenue cycle management use a _____ to collect information a…
A provision under which the insured pays a flat dollar amount…
Specified amount of money that the insured must pay for cover…
Accounts receivable
Accounts Receivable (A/R) Department -A department in a healt…
Charge capture
Revenue cycle management use a _____ to collect information a…
45 terms
Principles of Healthcare Reimbursement 10 questions
How do organizations control costs ind…
Why are incremental implementations of…
In value-based purchasing and pay-for-…
Which of the following incentives is n…
Reduce errors
Sponsors can evaluate policies and procedures.
Authoritarian
Public report cards
How do organizations control costs ind…
Reduce errors
Why are incremental implementations of…
Sponsors can evaluate policies and procedures.
48 terms
Principles of Healthcare Reimbursement Unit 1
Many American depend mainly on ______
Health Insurance reduces the risk of l…
Health Insurance first started with __…
In the U.S insurance often tied ______…
Health Insurance
Risk Pool
Blue Cross Blue Shield
Employment
Many American depend mainly on ______
Health Insurance
Health Insurance reduces the risk of l…
Risk Pool
143 terms
HIM 2430 -- Principles of Healthcare Reimbursement FINAL
True or False: A group of insureds wit…
Reimbursement for healthcare depends o…
True or false: The premiums received b…
True or false: Health insurance became…
True
health insurance
False. Insurance premiums do offset the loss the insurance co…
True
True or False: A group of insureds wit…
True
Reimbursement for healthcare depends o…
health insurance
56 terms
Principles of healthcare reimbursement chapter 1
Accountable care organization (ACO)
Affordable Care Act (ACA)
Allowable fee
Bad debt
Primary care and hospital organizations that have voluntarily…
Builds on existing systems to address three core problems: co…
Average or maximum amount the third party payer will reimburs…
Services for which healthcare organizations expected payment…
Accountable care organization (ACO)
Primary care and hospital organizations that have voluntarily…
Affordable Care Act (ACA)
Builds on existing systems to address three core problems: co…
11 terms
Principles of healthcare reimbursement Chapter 9
Accounts receivable
Charge capture
Charge description master
Fiscal intermediary
Department in a healthcare facility that manages the amounts…
Process of collecting all services procedures and supplies pr…
Database used by healthcare facilities to house the price lis…
Local payment branch of the Medicare program
Accounts receivable
Department in a healthcare facility that manages the amounts…
Charge capture
Process of collecting all services procedures and supplies pr…
35 terms
Principles of Healthcare reimbursement chapter 6
Add on
Arithmetic mean length of stay
Base payment rate
Case mix
Payment adjustment in a federal system that increases reimbur…
Sum of all lengths of stay in a set of cases divided by the n…
Rate per discharge for operating and capital related componen…
Set of categories of patients treated by a healthcare organiz…
Add on
Payment adjustment in a federal system that increases reimbur…
Arithmetic mean length of stay
Sum of all lengths of stay in a set of cases divided by the n…
49 terms
Principles of Healthcare Reimbursement Chapter 2
Abuse
AHA Coding Clinic for ICD-9-CM
AHA Coding Clinic for HCPCS
AHIMA Standards of Ethical Coding
Unknowing or unintentional submission of an inaccurate claim…
Only official publication for ICD-9-CM coding guidelines and…
Resource newsletter that provides coding advice for users of…
Standards developed to give coding advice and direction for I…
Abuse
Unknowing or unintentional submission of an inaccurate claim…
AHA Coding Clinic for ICD-9-CM
Only official publication for ICD-9-CM coding guidelines and…
18 terms
Principles of healthcare reimbursement chapter 4
Beneficiary
Civilian Health and Medical Program: V…
Federal Employees Compensation Act (FE…
Indian Health Service (IHS)
An individual who is eligible for benefits from health plan
A benefits program administered by the Department of Veterans…
A benefit program that ensures that civilian employees of the…
An agency within the Department of health and human services…
Beneficiary
An individual who is eligible for benefits from health plan
Civilian Health and Medical Program: V…
A benefits program administered by the Department of Veterans…
33 terms
Principles of healthcare reimbursement chapter 8
Activities of daily living
Add on
Base rate
Base year
Everyday tasks that people care perform without assistance an…
Payment adjustment in a federal system that increases reimbur…
Rate per discharge for operating and capital related componen…
Most recent 12 month period for which the centers for Medicai…
Activities of daily living
Everyday tasks that people care perform without assistance an…
Add on
Payment adjustment in a federal system that increases reimbur…
16 terms
Principles of Healthcare Reimbursement Chapter 7
RBRVS Formula
Resource-Based Relative Value Scale
Resource-Based Relative Value Scale pe…
Geographic Practice Cost Indices
[(WORK RVU) (WORK GPCI) + (PE RVU) (PE GPCI) + (MP RVU) (MP G…
Payment system that reimburses physicians' practice expenses…
Controlled Fee-for-Service System Based on CMS's Estimation o…
Geographic Practice Cost Index (GPCI) An adjustment that acco…
RBRVS Formula
[(WORK RVU) (WORK GPCI) + (PE RVU) (PE GPCI) + (MP RVU) (MP G…
Resource-Based Relative Value Scale
Payment system that reimburses physicians' practice expenses…
16 terms
Principles of Healthcare Reimbursement Chapter 7
RBRVS Formula
Resource-Based Relative Value Scale
Resource-Based Relative Value Scale pe…
Geographic Practice Cost Indices
[(WORK RVU) (WORK GPCI) + (PE RVU) (PE GPCI) + (MP RVU) (MP G…
Payment system that reimburses physicians' practice expenses…
Controlled Fee-for-Service System Based on CMS's Estimation o…
Geographic Practice Cost Index (GPCI) An adjustment that acco…
RBRVS Formula
[(WORK RVU) (WORK GPCI) + (PE RVU) (PE GPCI) + (MP RVU) (MP G…
Resource-Based Relative Value Scale
Payment system that reimburses physicians' practice expenses…
8 terms
Principles of healthcare reimbursement chapter 10
Attribution
Measure
Patient centered medical home
Pay for performance
Assignment of the costs of a patients care and the outcomes o…
The quantifiable data about a function or process
Model of healthcare delivery in which patients receive struct…
Type of providers payment system that is based on performance…
Attribution
Assignment of the costs of a patients care and the outcomes o…
Measure
The quantifiable data about a function or process
88 terms
Principles of healthcare reimbursement chapter 3
Actual charge
Adjudication
Adverse selection
Allowable charge
Amount provider actually bills a patient, which may deffer fr…
The determination of the reimbursement payment based on the m…
Enrollment of excessive proportion of persons with poor healt…
Average or maximum amount the third party payer will reimburs…
Actual charge
Amount provider actually bills a patient, which may deffer fr…
Adjudication
The determination of the reimbursement payment based on the m…
44 terms
Principles of healthcare reimbursement Chapter 5
Carve out
Case management
Cherry picking
Closed panel
Contracts that separate out services or populations of patien…
Coordination of individuals care over time and across multipl…
Targeting the enrollment of healthy patients to minimize heal…
Type of health maintenance organization that provides hospita…
Carve out
Contracts that separate out services or populations of patien…
Case management
Coordination of individuals care over time and across multipl…
8 terms
Principles of Healthcare Reimbursement Chapter 5
Benefits and Services
Characteristics of Managed Care
Characteristics of Managed Care
Characteristics of Managed Care
Physician services... Inpatient care... Preventive care and wellnes…
Selection criteria for providers... Delivery of continuum of car…
Quality assessment and improvement... Performance improvement ac…
Service management tools... Medical necessity review... Utilization…
Benefits and Services
Physician services... Inpatient care... Preventive care and wellnes…
Characteristics of Managed Care
Selection criteria for providers... Delivery of continuum of car…
7 terms
Principles of Healthcare Reimbursement Chapter 3
What is the relation between covered c…
Name at least two of the three benefit…
What type of insurance policy provides…
Why can use of a formulary be consider…
Covered conditions are those alterations in the health status…
1. Stop-loss benefit... 2. Maximum out-of-pocket costs ... 3. Catas…
a. Long Term Care policy... b. Disability Income Protection poli…
Formulary list limits what drugs the insurer will or will not…
What is the relation between covered c…
Covered conditions are those alterations in the health status…
Name at least two of the three benefit…
1. Stop-loss benefit... 2. Maximum out-of-pocket costs ... 3. Catas…
86 terms
Principles of Healthcare Reimbursement 9 & 10
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
46 terms
Principles of Healthcare Reimbursement, Chp 1, Part 1
the US healthcare system is inherently…
Insurance
risk pool
risk
it is actually multiple subsystems rather than a single system
a system of reducing a person's exposure to risk of loss by h…
group of persons with similar risks of loss
In healthcare, is the potential that a person will get sick o…
the US healthcare system is inherently…
it is actually multiple subsystems rather than a single system
Insurance
a system of reducing a person's exposure to risk of loss by h…
58 terms
Principles of healthcare reimbursement chapter 1
Accountable care organization (ACO)
Affordable Care Act (ACA)
Allowable fee
Bad debt
Primary care and hospital organizations that have voluntarily…
Brief name for Patient Protection and Affordable Care Act of…
Average or maximum amount the third party payer will reimburs…
Services for which healthcare organizations expected payment…
Accountable care organization (ACO)
Primary care and hospital organizations that have voluntarily…
Affordable Care Act (ACA)
Brief name for Patient Protection and Affordable Care Act of…
48 terms
Principles of healthcare reimbursement chapter 7
All inclusive reimbursement rate
Ambulatory payment classification
Ambulatory surgical center
Ancillary services
Reimbursement rate for federally qualified health centers and…
Hospital outpatient prospective payment system
Freestanding outpatient facility in which outpatient surgerie…
Professional healthcare services such as radiology, labs, or…
All inclusive reimbursement rate
Reimbursement rate for federally qualified health centers and…
Ambulatory payment classification
Hospital outpatient prospective payment system
55 terms
Principles of Healthcare Reimbursement Chapter 1 Introduction to Healthcare Reimbursement
Accountable care organization (ACO)
Affordable Care Act (ACA)
Allowable charge
Bad debt
Primary-care led physician and hospital organization that has…
Brief name for Patient Protection and Affordable Care Act of…
Average or maximum amount the third-party payer will reimburs…
Services for which healthcare organizations expected, but did…
Accountable care organization (ACO)
Primary-care led physician and hospital organization that has…
Affordable Care Act (ACA)
Brief name for Patient Protection and Affordable Care Act of…
86 terms
Principles of Healthcare Reimbursement 9 & 10
Which of the following points is a gui…
What is the average of the sum of the…
Select the highest level of the IPPS h…
What is the general term for software…
Incentive for cost control because hospitals retain profits o…
Case mix index
Major diagnostic category
Grouper
Which of the following points is a gui…
Incentive for cost control because hospitals retain profits o…
What is the average of the sum of the…
Case mix index
45 terms
Principles of Healthcare Reimbursement 10 questions
How do organizations control costs ind…
Why are incremental implementations of…
In value-based purchasing and pay-for-…
Which of the following incentives is n…
Reduce errors
Sponsors can evaluate policies and procedures.
Authoritarian
Public report cards
How do organizations control costs ind…
Reduce errors
Why are incremental implementations of…
Sponsors can evaluate policies and procedures.
40 terms
Principles of Healthcare Reimbursement 4th Ed Chapter 1
Accountable Care Organization - ACO
Affordable Care Act - ACA
Allowable fee
Bad debt
Primary-care led physician and hospital organization that vol…
Brief name for Patient Protection Act of 2010, as amended by…
Same as allowable charge - average or maximum amount the thir…
Services for which health care organizations expected but did…
Accountable Care Organization - ACO
Primary-care led physician and hospital organization that vol…
Affordable Care Act - ACA
Brief name for Patient Protection Act of 2010, as amended by…
49 terms
Principles of Healthcare Reimbursement Chapters 6-10
PPS
CMS
DRG
RW
Prospective Payment System
Centers for Medicare and Medicaid
Diagnosis-related groups
Relative weight
PPS
Prospective Payment System
CMS
Centers for Medicare and Medicaid
60 terms
Principles of Healthcare Reimbursement- quiz 1-6
The health plan reimburses Dr. Tan $15…
In the United States, what is healthca…
In which type of reimbursement methodo…
The physician's office sent a request…
Capitated rate
Reduction of a person's or a group's exposure to risk for unk…
Global payment
Claim
The health plan reimburses Dr. Tan $15…
Capitated rate
In the United States, what is healthca…
Reduction of a person's or a group's exposure to risk for unk…
158 terms
Principles of Healthcare Reimbursement: Ch 1-5
reimbursement
insurance
risk pool
deductible
Compensation or repayment for healthcare services already ren…
Reduction of a person's risk of loss by having another party…
Group of people who will be covered by a healthcare insurance…
Annual amount of money that the policyholder must incur and p…
reimbursement
Compensation or repayment for healthcare services already ren…
insurance
Reduction of a person's risk of loss by having another party…
23 terms
Principles of Healthcare Reimbursement, Chp 1, Part 2
Episode-of-Care Reimbursement
Episode of Care
Forms of Episode-of-Care
Capitated Payment Method/Capitation
A healthcare payment method in which providers receive one lu…
An episode of care is the health services that a patient rece…
Capitated, Global, and Prospective Payment Methods
Third-party payer reimburses providers a fixed, per capita am…
Episode-of-Care Reimbursement
A healthcare payment method in which providers receive one lu…
Episode of Care
An episode of care is the health services that a patient rece…
Principles of Healthcare Reimbursement 5th Edition Chapter 6
add-on
arithmetic mean length of stay
base payment rate
case mix
payment adjustment in a federal system that increases reimbur…
sum of all lengths of stay in a set of cases divided by the n…
1. rate per discharge for operating and capital-related compo…
set of categories of patients (type and volume) treated by a…
add-on
payment adjustment in a federal system that increases reimbur…
arithmetic mean length of stay
sum of all lengths of stay in a set of cases divided by the n…
40 terms
Principles of Healthcare Reimbursement 4th Ed Chapter 1
Accountable Care Organization - ACO
Affordable Care Act - ACA
Allowable fee
Bad debt
Primary-care led physician and hospital organization that vol…
Brief name for Patient Protection Act of 2010, as amended by…
Same as allowable charge - average or maximum amount the thir…
Services for which health care organizations expected but did…
Accountable Care Organization - ACO
Primary-care led physician and hospital organization that vol…
Affordable Care Act - ACA
Brief name for Patient Protection Act of 2010, as amended by…
55 terms
Principles of Healthcare Reimbursement 5th edition - Chapter 1
Accountable care organization (ACO)
Affordable Care Act (ACA)
Allowable charge
Block grant
Primary care-led physician and hospital organization that has…
Brief name for Patient Protection and AffordableCcare act of…
Average or maximum amount the third party payer will reimburs…
Fixed amount of money given or allocated for a specific purpo…
Accountable care organization (ACO)
Primary care-led physician and hospital organization that has…
Affordable Care Act (ACA)
Brief name for Patient Protection and AffordableCcare act of…
46 terms
Principles of Healthcare Reimbursement, Chp 1, Part 1
the US healthcare system is inherently…
Insurance
risk pool
risk
it is actually multiple subsystems rather than a single system
a system of reducing a person's exposure to risk of loss by h…
group of persons with similar risks of loss
In healthcare, is the potential that a person will get sick o…
the US healthcare system is inherently…
it is actually multiple subsystems rather than a single system
Insurance
a system of reducing a person's exposure to risk of loss by h…
44 terms
Principles of Healthcare Reimbursement Chapters 5-8 Review
Capitation
Carve Out
Case Management
Cherry Picking
System of payment used by managed care plans in which physici…
eliminating a certain specialty of health services from cover…
Model of care; the case manager advises nursing staff on spec…
A process used by private insurers that only tries to cover t…
Capitation
System of payment used by managed care plans in which physici…
Carve Out
eliminating a certain specialty of health services from cover…
60 terms
Principles of Healthcare Reimbursement- quiz 1-6
The health plan reimburses Dr. Tan $15…
In the United States, what is healthca…
In which type of reimbursement methodo…
The physician's office sent a request…
Capitated rate
Reduction of a person's or a group's exposure to risk for unk…
Global payment
Claim
The health plan reimburses Dr. Tan $15…
Capitated rate
In the United States, what is healthca…
Reduction of a person's or a group's exposure to risk for unk…
58 terms
Principles of Healthcare Reimbursement 4th Ed Chapter 1
Accountable Care Organization - ACO
Affordable Care Act - ACA
Allowable fee
Bad debt
Primary-care led physician and hospital organization that vol…
Brief name for Patient Protection Act of 2010, as amended by…
Same as allowable charge - average or maximum amount the thir…
Services for which health care organizations expected but did…
Accountable Care Organization - ACO
Primary-care led physician and hospital organization that vol…
Affordable Care Act - ACA
Brief name for Patient Protection Act of 2010, as amended by…
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