Healthcare Delivery Models

Question 1

What are government plans?

Answer 1

Medicare: over 65
Part A Hospitalization
Part B Office Visits
Part D Medications
Medicaid: cant pay, low income

Question 2

TriCare

Answer 2

Active duty service / family

Question 3

CHAMPVA

Answer 3

Veteran’s Affairs

Question 4

Private Plans thru Employer

Answer 4

Group/ individual
Oldest -BCBS

Question 5

Worders Comp

Answer 5

Paid by employer for incidents at work

Question 6

Insurance Terminology

Question 7

Allowed amount

Answer 7

Max amount third party will pay

Question 8

CoPay

Answer 8

set amount patient pays at time of service

Question 9

CoInsurance

Answer 9

Member & insurance company split cost, usually 80/20%

Question 10

Deductible

Answer 10

Amount of money paid out of pocket, before insurance company begins paying

Question 11

Billing FORM

Answer 11

CMS 1500

Question 12

Direct Billing

Answer 12

Provider submit direct to insurance

Question 13

ClearingHouse

Answer 13

Submit claims using software, house audits, sorts, scrubs for mistakes

Question 14

Medicare / Medicaid

Answer 14

Invoice cannot exceed 12 months from service

Question 15

Key Terms

Question 16

Ambulatory care

Answer 16

patient can walk

Question 17

Managed Care

Answer 17

Plans provide care in return for scheduled payments

Question 18

Osteopathic

Answer 18

medicine based on musculoskeletal system, manipulation. Affects other body parts. Conventional, pharmacology, therapeutic procedures

Question 19

Professionalism

Answer 19

Skills, behavior & judgement that represent best qualities

Question 20

Work Ethic

Answer 20

Values based on moral virtues and diligence