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10 Cards in this Set

  • Front
  • Back

Group Policies

Medical insurance obtained through jobs

Individual Policies

Medical insurance for the self-employed, generally more expensive.

Third Party Payer

Insurance company or program that reimburses medical expenses

Medical insurance

Third party payer, insurance covers policyholders and dependents (aka private insurance)

Medicare

Third party payer, federal program that covers persons over 65 or those younger that fall into disability category.

Medicaid

Third party payer, federal/state program that provides health care coverage to certain populations of the poor.

Workers' compensation

Third party payer, program that provides coverage for individuals who are injured on the job or acquire job-related illnesses.

TRICARE

Third party payer, federal program that covers military personnel and families.

CHAMPVA

Third party payer, federal program that provides health care coverage to spouses and dependents of veterans with total service-related disabilities or those who died from service-related disabilities.

Flow of Reimbursement

(1) Pt. admitted to hospital


(2) Diagnoses and procedures documented in medical records


(3) Numeric codes assigned to diagnoses and procedures


(4) Codes entered on claim form


(5) Claim form submitted to insurance or Third party payer


(6) Reimbursement paid to hospital