Healthcare Delivery
This insurance model is also known as universal healthcare
What is Social Insurance Model?
A statistical process that considers patients' underlying health status and health spending when examining their healthcare outcomes or healthcare costs.
What is risk adjustment?
The three components of the revenue cycle include:
What is front-end, middle process, and back-end process?
This is the annual amount of money that a policyholder must pay before the health insurance plan assumes its share of liability.
What is deductible?
Proposed changes to federal payment systems must be publicized in advance of the effective date through a process known as __________.
What is notice of proposed rule making?
The healthcare provider is the ______ party.
What is second party?
The amount paid to a healthcare provider for services provided to a patient.
What is reimbursement?
Supervision of all the administrative and clinical functions that contribute to the capture, management, and collection of patient service reimbursement
What is revenue cycle management?
This portion of Medicare covers home health services, hospice care, and skilled nursing facility services.
What is Medicare Part A?
The Hospital VBP will measure hospital performance based on these four domains:
What are clinical outcomes, person and community engagement, safety, and efficiency and cost reduction?
Health insurance was first utilized in this U.S. state in 1929.
What is Texas?
The amount that the third party payer or insurance company will pay for a service.
What is allowable charges?
Three primary benefits of an integrated revenue cycle (IRC) include:
What are reduced cost to collect, performance consistency, and coordinated strategic goals?
Policyholders as patients have an incentive to use more services than those on which their insurance are based.
What is moral hazard?
This type of payment provision provides acute care facilities with financial relief in cases where the costs of treatment are very high when compared to the average costs for cases in the same MS-DRG.
What is a high cost outlier?
This legislation allows people to extend their health insurance after losing their job.
What is the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)?
The method of payment for health services is one in which the third-party payer reimburses providers a fixed, per capita amount for a period.
What is capitation?
Services are delivered to the patient; charges captured are part of this revenue cycle process.
What is middle process?
A pre-established percentage of eligible expenses after the deductible has been met.
What is coinsurance?
The _______ is a classification system used in PDPM to place residents into groups of similar clinical reason for stay and function levels.
What is case-mix group (CMG)?
The _______ is the value of all goods and services made within a country
What is Gross Domestic Product (GDP)?
This type of reimbursement methodology is based on the actual resources expended to deliver the services and is finalized after the services are delivered.
What is retrospective reimbursement?
Completing one’s assigned revenue cycle tasks by following the provided procedure and all rules. It also includes speaking up if the procedure is not working or is causing extra steps or rework.
What is revenue integrity?
This type of plan combines health insurance and the delivery of healthcare services. This plan emphasizes preventative care in the belief that preventative care saves money by preventing acute illness and chronic conditions.
What is HMO or Health Maintenance Organization?
These services and supplies are included in the non-case mix component of the SNF payment system.
What are room and board services?