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18 Cards in this Set

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  • Back
Retrospective Reimbursement
A reimbursement System in which the rates are set based on the costs already incurred
(after service)
Underwriting
Systematic technique for evaluating,selecting( or rejecting), classifying and rating risks
Job lock
The inability of a person to change jobs for fear of loosing health insurance coverage
Community rating
Determination of insurance premiums based on spreading the risk among members of a large community
Prospective reimbursement
A reimbursement system using pre-established criteria to determine in advance the amount of reimbursement a provider will recieve (before service)
MSA
a tax free saving account used for health care costs
GDP
total value of all goods and services produced by the country in one year
Experience Rating
Determination of insurance premiums based on the groups own medical claim experience
Risk
in the context of insurance, the possibility of substancial financial loss
Medigap
Private insurance policy for the elderly to cover expenses not covered by medicare
Entitlement Program
Program where people recieve benefits because they previously contributed to the program
Stop-loss policy
this type of insurance pays 100% after you reach the maximum out of pocket liability set in the policy
Catastrophic policy or plan
A high deductible insurance plan designed NOT to cover routine services
Cost Plus Reimbursement
A reimbursement method in which the per diem rate is set using all operating costs & allowable capital costs
What is Medicare Part A? Discuss the financing and cost sharing features of Medicare Part A. What benefit does Part A it cover?
What benefits are not covered?
Medicare part A is Hospital Insurance. It is financed by special payroll taxes collected for social security. The employer and employee share equally in financing the Hospital Insurance Trust Fund.
Part A covers:
1. a max of 90 days inpatient services ( once the 90 days is exhausted, a lifetime reserve of 60 additional hodpital inpatient remains.
2.pays up 100 days of SNF, Medicare pays for home health care when a person is homebounded a rquires a VCA
3. coversw first 100 visits following a SNF or hospital stay
4. For terminally ill pts (certified hospice)
What is medicare Part B? Discuss the financing and cost sharing features of Medicare Part B. What benefits are covered under Part B? What benefits are not covered?
Medicare part B is the supplementary medical insurance (SMI)portion of medicare, is a voluntary program financed partly by general tax revenues and partially by required premium contributions.
What are the major methods of reimbursement for outpatient services?
adfjalsjdf (216)
What are the differences between retrospective and prospective methods of reimbursement?
(pg 214)