Chapter 6 Reimbursement Methodologies

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Across
  1. 4. A holder of a health insurance policy
  2. 5. A type of short-term care provided to relieve the family home caregiver
  3. 9. purpose is to obtain a higher level of payment
  4. 10. Model of HMO employs physicians and healthcare professionals to provide healthcare services to members
  5. 11. Preestablished percentage of eligible expenses after the deductible has been met
  6. 14. private health insurance pays healthcare service charges not covered by Medicare Part A or B
  7. 16. Computer program that assigns inpatient cases to groups by diagnosis to determine the Medicare reimbursement rate
  8. 18. Payment system where amount due is determined before the service is rendered
  9. 19. A reimbursement method used to issue payments in lump-sums to providers to compensate them for all the services rendered to a patient for an illness during a specific time period
  10. 21. Progam for dependents and survivors of disabled veterans
  11. 24. Provides healthcare services to American Indians and Alaska natives
  12. 25. Medical condition coexsisting with primary cause for hospitalization and affects treatment or length of stay
Down
  1. 1. Model of healthcare services contracted with two or more multispecialty group practices
  2. 2. Model of HMO that is created when physicians join together in an organized group to fulfill a contract while retaining individual practices
  3. 3. Federally funded health program for Americans 65 years of age and older
  4. 6. Issues payments to healthcare providers on charges assigned to each of the separate services that were performed for the patient
  5. 7. Practice of using multiple codes to bill for various individual steps in a single procedure rather than using a single code that includes all the steps
  6. 8. Method of healthcare reimbusement which an insurance carrier prepays a provider a fixed amound for a given population without regard to the actual number or nature of healthcare services provided to the population
  7. 11. Itemized statement of healthcare services and their costs submitted for reimbursement to healthcare insurance plans
  8. 12. Lists the individual charges for every element in providing a service
  9. 13. Health administration for the retired armed forces
  10. 15. Model of HMO which providers agree to devote a fixed percentage of their practice time to the HMO
  11. 17. Entitlement program that oversees medical assistance for individuals and families with low incomes and limited resources
  12. 20. Payments are issues that are considered customary for the community and reasonable for the situation
  13. 22. Amount of money paid to insurer periodically in return for healthcare coverage
  14. 23. Healthcare Program for active duty armed forces and retirees, guard, reserve, and their dependents