Exam 7: Reimbursement

The 82-year-old patient presented in the physician's office for a routine physical examination. He gave the receptionist two cards, evidencing his primary, government-funded insurance plan that pays for most of the bill and an additional, private plan that covers the remaining charges. The patient's secondary insurance is called:

What patient attributes are important to grouper assignment?

A ______________ is a type of third party payer arrangement in which an individual is responsible for a percentage of the amount owed to the provider.

The major benefit of a flexible benefit (medical savings) account is:

The amendment to the Social Security Act that established Medicare is __________.

The system of exchanging professional services instead of paying for services in cash is called ____________.

The blending of the insurance and provider roles in health care delivery is characteristic of _________.

The physician charged the patient $75 for an office visit. The patient paid the physician $5 and the patient's insurance company paid the physician $70. The patient's portion of the payment is called:

The Medicare patient presented to the emergency department with exacerbation of COPD. The patient was treated and released. The emergency department charges were $430. Two days later, the patient returned to the emergency department with congestive heart failure. The length of stay for the admission was 2 days. The inpatient charges were $4,700. The DRG amount was $3,500. The hospital should bill Medicare for:

The application to an insurance company for reimbursement is called the ______________.

Medicare is a federal funded program available to those age 65 and older and those on permanent disability. However, there are many different programs that Medicare offers that are called Parts. How many parts does Medicare have and what services are offered? What does the federal program pay for and what is the patient responsible for?

Discuss Medicaid, including administration and eligibility.

A contractor who manages health care claims for Medicare is a:

A patient was treated by his primary care physician. Upon leaving the office, the patient gave the physician a $10 co-pay. This patient's insurance plan is most likely a(n):

Major Diagnostic Categories (MDCs) usually consist of which two main sections?

The coordination of the patient's care and services, including reimbursement considerations, is characteristic of ___________.

Which of the following is true about the Resident Assessment Instrument (RAI), used to collect data in skilled nursing facilities?

When hospitals began being reimbursed based on DRG assignment, patient length of stay decreased because:

The payment rate established by an insurance company, based on its knowledge of the regional charges for a service, is called: