1
Third party Reimbursement was coined to indicate payment of services rendered by?
Someone other than the patient
Third-party payers are an insurance carrier who?
is not the physician or patient but who intervenes to pay the hospital or medical bills
Third-party liability is furnished under what plan?
State plan
Some individuals choose higher premiums to have more flexibility to seek medical care from health care professionals of their choice. This is known as?
Fee for service care
What is a subscriber
the person who has been insured an insurance policy holder
HEDIS consists of?
performance measures to evaluate managed care plans
Blue Cross Blue Shield health insurance plans are generally well known ex. of?
commercial health insurance plans
Coinsurance is?
The percentage owed by the pt for services rendered after a deductible has been met and co payment has been made
Indemnity-type insurance has the?
least amount of structural guidelines for pts to follow
Indemnity is also referred to as?
80/20 plan
HMOs require? And who is responsible for referring the pt?
Requires a PCP, and the PCP is responsible for referring the pt
PCP is sometimes referred to as?
The Gatekeeper
Health savings account HSA is?
A tax-sheltered savings account that can be used to pay for medical expenses
Flexible Spending Arrangement FSA is?
Sometimes referred to as a cafeteria plan. This is a "use it or lose it" type of plan
Who qualifies for Medicare?
People over 65 yrs who meet the eligibility requirements and have filed for coverage. In addition, people who are disabled, receive SS benefits, end stage renal disease, regardless of age, are eligible
Medicare Part A covers, and the annual deductible does what every yr.
Medicare Part B is for?
payment of other medical expenses, including OV, X-ray, and lab services, and the services of a provider in or out of the hospital
Medicare Part C also known as?
Medicare Advantage
Medicare Part C does what?
Enables beneficiaries to select a managed care plan as their primary coverage
Medicare Part D covers?
Drugs
Providers who choose not to be a participating provider can only charge what % above the Medicare participating provider fee schedule
15
If the provider does provide a service that is not covered, the pt must be informed in advance and must sign?
Advance Beneficiary Notice ABN
What are the 4 types of state benefits under workers' comp?
Tricare and Champva cover?
Active service personnel and their dependents, retired service personnel, and their dependents, and dependents of service personnel who died in active duty