Health Insurance
Payment
Medicare
Coding
Govt Sponsored HC Plans
100
Compensation or repayment for healthcare services that have already been rendered.
What is reimbursement?
100
The payer learns of the costs of the health services after the patient has already received the service.
What is a retrospective payment method?
100
This program offers outpatient drug coverage provided by private prescription drug plans and Medicare Advantage.
What is Medicare Part D?
100
It is used to report diagnoses in all healthcare settings and procedures for inpatient encounters and is used throughout the world for mortality reporting.
What is the International Classification of Diseases (ICD)?
100
This program was designed to enhance the quality of life for the frail elderly population by enabling them to live in their own homes and communities and to preserve and support their family units.
What is PACE?
200
The amount of money that a policy holder or certificate holder must periodically pay a healthcare insurance plan in return for healthcare coverage.
What is a premium?


200
A type of episode-of-care reimbursement in which the payments are preset before care is delivered.
What is a prospective payment method?
200
This supplemental medical insurance is an optional insurance package that beneficiaries can purchase that covers physician services, medical services, and medical supplies that aren't already covered.
What is Medicare Part B?
200
This is used throughout the United States to report diagnostic and surgical services and procedures.
What is (CPT) Current Procedural Terminology?
200
This is a state-federal partnership that targets the growing number of children not covered by health insurance.
What is CHIP?
300
A fixed amount owed for a healthcare service, due at the time the services are provided.
What is a co-payment?
300
A healthcare payment method in which providers retrospectively receive payment for each service rendered.
What is fee-for-service reimbursement?


300
This inpatient hospital insurance is provided with no premiums to most beneficiaries, but most services covered under this benefit require an annual deductible and copayment be paid by the beneficiaries.
What is Medicare Part A?
300
This was developed by CMS in the 1980s to report services, supplies, and procedures.
What is HCPCS?
300
This is a joint program between the federal and state governments to provide healthcare benefits to low-income persons and families.
What is Medicaid?
400
The amount owed by the patient for healthcare services before the plan begins to pay.
What is a deductible?
400
It is a type of fee-for-service reimbursement in which the patients or their guarantors pay a specific amount for each service received.
What is self-pay?
400
This is a managed care option known as Medicare Advantage.
What is Medicare Part C?
400

This is the official CPT code set 96150-96168 for services that address psychological, behavioral, emotional, cognitive, and interpersonal factors in the treatment or management of physical health problems. This code set must ALWAYS include a medical ICD-10 CM diagnosis reported as primary on the claim. 

What are Health Behavior Assessment and Intervention, HBAI codes? 

400
This program provides states with grant money designated to provide low-income families with care assistance.
What is TANF?
500
Cost sharing in which the policy or certificate holder pays a preestablished percentage of eligible expenses after the deductible has been met.
What is coinsurance?
500
Healthcare payment method in which providers receive one lump sum for all care they provide related to a condition or disease.
What is episode-of-care reimbursement?
500
A type of private insurance policy available for Medicare beneficiaries to supplement Medicare Part A and/or Part B coverage.
What is Medigap?
500

These 2023 CPT guideline changes that were effective as of Jan 1, 2023 avoid inpatient/observation note-bloat within documentation for E/M services and simplify code leveling purposes. Impacting codes: 99221-99223, 99231, 99233, 99238-99239, 99234-99236. 

What is Medical Decision Making and Time Based Billing? 

500
This benefit is provided to most employees to cover healthcare costs and lost income from a work related injury or illness.
What is worker's compensation?
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