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11 Cards in this Set

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  • Back
A method of reimbursing providers (usually physicians) with a fixed payment typically expressed as a per-member-per-month payment that is made in advance for future anticipated contracted health services.
The federal government agency that administers Medicare and Medicaid. Formerly known as the Health Care Financing Administration (HCFA).
Centers for Medicare and Medicaid Services (CMS)
Refers to reimbursement based on a predetermined fixed price per case or diagnosis for clients in 468 categories.
DRGs (diagnosis-related roups_
The total output of all goods and services in the country.
GDP (gross domestic product)
The federal government agency that administered Medicare and Medicaid until 2001.
Health Care Financing Administration (HCFA)
An economic term that refers to the change in some variable (e.g., the number of tests performed).
A jointly sponsored state and federal program that pays for medical services for persons who are elderly, poor, blind, or disabled and for families with dependent chldren.
A federally funded health insurance program for the disabled, persons with end-state renal disease, and persons 65 years of age and older who qualify for social security benefits.
A method of reimbursing health care proviers (i.e., physicians, hospitals) in which the total amount of payment for care is predetermined based on the patient's diagnosis; provides for a "set price per diagnosis" payment system in contrast to the retrospective or "fee-for-service" system; encourages increased efficiency in the use of health care services since providers are reimbursed at a set level regardless of how any services are rendered or procedures performed to treat a particular diagnostic category; predominant method of payment in today's helath care system
Prospective payment system
a method of reimbursing health care prociders (i.e., physicians, hospitals) in which professional services are rendered and charges are billed based on each individual service provided; also known as the "fee-for-service" payment system. This system encourages overuse of health care services because the moreservices rendered or procedures performed, the more revenue received by providers.
Retrospective payment system
An organization other than the patient and the supplier (hospital or physician), such as an insurance company, that assumes responsibility for payment of health care charges.
Third party