Soc Week 6

Front 1

Retrospective Reimbursement

Back 1

A reimbursement System in which the rates are set based on the costs already incurred
(after service)

Front 2

Underwriting

Back 2

Systematic technique for evaluating,selecting( or rejecting), classifying and rating risks

Front 3

Job lock

Back 3

The inability of a person to change jobs for fear of loosing health insurance coverage

Front 4

Community rating

Back 4

Determination of insurance premiums based on spreading the risk among members of a large community

Front 5

Prospective reimbursement

Back 5

A reimbursement system using pre-established criteria to determine in advance the amount of reimbursement a provider will recieve (before service)

Front 6

MSA

Back 6

a tax free saving account used for health care costs

Front 7

GDP

Back 7

total value of all goods and services produced by the country in one year

Front 8

Experience Rating

Back 8

Determination of insurance premiums based on the groups own medical claim experience

Front 9

Risk

Back 9

in the context of insurance, the possibility of substancial financial loss

Front 10

Medigap

Back 10

Private insurance policy for the elderly to cover expenses not covered by medicare

Front 11

Entitlement Program

Back 11

Program where people recieve benefits because they previously contributed to the program

Front 12

Stop-loss policy

Back 12

this type of insurance pays 100% after you reach the maximum out of pocket liability set in the policy

Front 13

Catastrophic policy or plan

Back 13

A high deductible insurance plan designed NOT to cover routine services

Front 14

Cost Plus Reimbursement

Back 14

A reimbursement method in which the per diem rate is set using all operating costs & allowable capital costs

Front 15

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?

Back 15

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)

Front 16

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?

Back 16

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.

Front 17

What are the major methods of reimbursement for outpatient services?

Back 17

adfjalsjdf (216)

Front 18

What are the differences between retrospective and prospective methods of reimbursement?

Back 18

(pg 214)