Chapter 14

Question 0

charity care

Answer 0

health care services that are provided to patients and for which no compensation is expected

Question 1

capitation fee

Answer 1

paid by an insurance company or other third-party payor to a health care organization, that is based on number of persons covered rather than on actual services provided

Question 2

contractual adjustment

Answer 2

difference between established billing rates and third-party-payer payments

Question 3

DRGs

Answer 3

Diagnosis-related groups

Question 4

Diagnosis-related groups

Answer 4

under medicare, a classification scheme of patient conditions used for purposes of reimbursement.

Question 5

Health maintenance organizations

Answer 5

organization that provides health care on a prepaid basis

Question 6

hmo

Answer 6

health maintenance organization

Question 7

malpractice claims

Answer 7

claim caused by professional negligence by a health care provider and causes injury or death of the patient

Question 8

PPO

Answer 8

Preferred provider organization

Question 9

Preferred Provider Organization

Answer 9

groups of doctors, hospitals, and other health care providers that contract with employers or insurance companies to provide medical services to a specified group of patients

Question 10

prospective payment system

Answer 10

medicare payment system that reimburses hospitals based on the nature of patients’ illnesses.

Question 11

retrospective payments

Answer 11

insurance policy that requires at the expiration of the policy for premium costs to be adjusted to actual loss experienced

Question 12

third-party payor

Answer 12

with respect to health care, the insurance company or party other than the patient that pays for services.

Question 13

retrospective insurance premiums

Answer 13

anticipated additional insurance premiums shoudl be recognized as expenses in the periods to which they are applicable