FINANCIAL CONSIDERATIONS Flashcards

1
Q

these must be collected at the time of service to increase cash collections for practice, which supports the revenue cycle…

A

Out-of-pocket expenses

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2
Q

it is not considered as part of the cost share
it must be paid monthly
it is paid by insured or employer
it is mandatory

A

Premium

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3
Q

it must meet a certain amount yearly
it is paid by insured
it is a fixed amount
it must be paid before insurance will start paying for the covered benefits

A

Deductible

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4
Q

deductible must be paid before this takes place
it is the amount shared with the Payer and Insured
the Payer usually pays more

A

Coinsurance

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5
Q

it is paid at the time of service
it is a fixed amount
the amount of payment varies on type of visit

A

Copayment

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6
Q

it is the most a member/family pay out of pocket for that given year

A

Out of Pocket Maximum (OOPM)

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7
Q

patients who do not have insurance and pays in these ways

A

Self-pay pts, self-pay or private pay

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8
Q

another payment option where it’s offered as employee benefits during open enrollment
the funds are tax-exempt
employer deducts a set amount from ea paycheck

A

Health Savings Account (HSA)

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9
Q

this form serves as informed consent to transfer responsibility to the patient if Medicare does not pay for the service
documents the beneficiary’s decision about a service or procedure that Medicare may cover

A

Advance Beneficiary Notice of Noncoverage (ABN)

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10
Q

it can either be private or group

A

Commercial health plans

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11
Q

it covers the cost of health care services for the individual and/or family after the deductible and copays have been met

A

Insurance policies

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12
Q

the more freedom a plan offers…

A

the higher the pt responsibility will likely be

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13
Q

allows the patient to see providers within the network
no referrals required
more freedom to access the benefits
have coinsurance and deductible requirements
have a contracted group of providers
also called Fee-for-service (FFS)
monthly premium required

A

Preferred Provider Organization (PPO) plans

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14
Q

it also have a contracted groups of providers, but, pt must choose a pcp

A

Point-of-service (POS) plans

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15
Q

has a contract with a network pf providers for pt care
reimburse providers using a capitation method
no limit to the no. of times a pt may be seen

A

Health Maintenance Organization (HMO) plans

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16
Q

a government plan that was establish in 1965
largest health insurance program in the US
eligible for individuals 65 yrs old or older

A

Medicare

17
Q

oversees the operations of Medicare

A

Centers for Medicare & Medicaid Services (CMS)

18
Q

selected by CMS to process Part A, B, FFS claims, & DME

A

Medical Administrative Contractors (MAC)

19
Q

composed of Medicare Advantage (MA) programs that allow all the same benefits as traditional Medicare and additional vision & dental services

A

Medicare Part C

20
Q

it is a program to assist qualified individuals who have low income with premiums, deductibles, copays, and coinsurance

A

Dual eligibility

21
Q

complete the parts of Medicare program from A-D

A

Part A - inpatient services
Part B - outpatient services
Part C - Medicare Advantage
Part D - Rx, Prescription

22
Q

a government program that assists qualified individuals with health care needs

A

Medicaid

23
Q

a supplemental policy to Medicare & offered by private insurance companies
help cover the costs of services that traditional Medicare doesn’t cover

A

Medigap

24
Q

a government program for active military and their families
retirees and surviving spouses also qualify

A

TRICARE

25
Q

members of TRICARE must be enrolled in this system

A

Defense Enrollment Eligibility Reporting Systems (DEERS)

26
Q

it is a method used reimburse providers to receive pre-established payments for health care services
no limit to number of times PT may be seen
reimbursement is the same
its period happens per month

A

Capitation Method