A
is a contract between an insurance company and a consumer. The company agrees to pay all or some of the insured person's healthcare costs in return for payment of a monthly premium.
Health Insurance
+200
Which type of Healthcare Plans are normally the most affordable?
HMO
+100
Which type of Healthcare Plans are normally the more expensive?
PPO
+200
What does PFFS stands for?
Private Fee For Service
+200
What does POS stands for in HMO-POS?
HMO Point of Service
+300
This part is for Prescription coverage.
Part D
+200
This type of healthcare insurance can be directly purchased by an individual or a family from an insurance provider.
Private Insurance
+300
This is requested by the payor based on the patient’s treatment. These can be either Covered or not covered
payment (or reimbursement)
+100
are defined as a person under health care. The person may be waiting for this care or may be receiving it or may have already received it
Patients
+400
What does PPO stands for?
Preferred Provider Organization
+300
What does HMO stands for?
Health Maintenance Organization
+500
This part includes part a and b + additional benefits
Part C
+300
This type of healthcare insurance is provided by entities for businesses/organizations. It includes many benefits such as preventative care, hospitalization, prescribed drugs.
Commercial Insurance
+200
are modern medical facilities specializing in out-patient surgical procedures. ASC services do not exceed 24 hours in duration and tend to focus on an area of care
Ambulatory surgery centers (ASCs), or out-patient surgery centers
+200
These are formal requests by someone who has an insurance policy to the insurance company for payment or compensation
Claims
+300
Can you enumerate the steps in the Healthcare Reimbursement Cycle
1 Treatment
2 Generate Claim
3 Pay Claim
4 Pay Bill
+1000
are people or entities that provide medical care or treatment
Healthcare providers
+300
This part is for Hospital coverage
Part A
+300
This type of healthcare payors include U.S. government-funded health insurance plans like Medicare and Medicaid. These programs help support certain populations and economic statuses.
Government
+400
is a U.S. federal government program, which pays for certain healthcare services. The Centers for Medicare and Medicaid Services (CMS) administrates them.
Medicare
+300
A type of physician that can be assigned to a member. Examples are Family doctors and Pediatrician
Primary Care Physician
+400
is a U.S. Federal-State matching entitlement program that pays for medical assistance for needy individuals and families with low incomes and resources. It is funded by state and federal taxes and programs vary per state.
Medicaid
+500
A type of physician that has a specialization and cannot be assigned.Examples are Otolaryngologist, Anesthesiologists and Dermatologists.
Specialty Care Physician
What other term do we use for Part A and B?
Original Medicare
+500
is a way of caring for people in their own home rather than going to a facility. Examples are:
Skilled nursing care, Physical therapy and Occupational therapy
Home care services
+300
Give us the qualifications for Medicare
•Persons 65 years and over-must qualify by paying 10 years of 40 quarters of Social Security Tax prior to age 65
•Persons Physically Disabled
•Persons Diagnosed with permanent kidney failure ESRD (End state renal disease)
•Spouses of those medically eligible (must meet above condition)
provides intensive care to patients on a short-term basis
Acute Care Hospitals
+300
provides intensive care to patients on a long-term basis
Chronic Care Hospitals or Long Term Care Hospitals
+200
is a special way of caring for people who are terminally ill, and for their family.
This care includes physical care and counseling.
Hospice
+200
This part is for Medical coverage
Part B
+100