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Revenue Management and Reimbursement (Key Terms) Terms in this set (87)CMS identified eight hospital-acquired conditions (not present on admission) as "reasonably preventable," and hospitals will not receive additional payment for cases in which one of the eight selected conditions was not present on admission; the eight originally selected conditions include: foreign object retained after surgery, air embolism, blood incompatibility, stage III and IV pressure ulcers, falls and trauma, catheter-associated urinary tract infection, vascular catheter-associated infection, and surgical site infection—mediastinitis after coronary artery bypass graft; additional conditions were added in 2010 and remain in effect: surgical site infections following certain orthopedic procedures and bariatric surgery, manifestations of poor glycemic control, and deep vein thrombosis (DVT)/ pulmonary embolism (PE) following certain orthopedic procedures. Students also viewedSets found in the same folderOther sets by this creator
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Accounting: What the Numbers Mean9th EditionDaniel F Viele, David H Marshall, Wayne W McManus 345 solutions Business Math17th EditionMary Hansen 3,734 solutions This type of medical insurance is an optional and supplemental portion of Medicare for which beneficiaries pay a monthly premium. This assists with coverage for physicians' services and outpatient care. It also insures other medical services not covered under Part A, such as some physical and occupational therapists' services, and some home healthcare. It pays for these covered services and supplies when they are medically necessary. To be medically necessary, the services or supplies required to diagnose or treat a medical condition meet accepted standards of medical practice. Services covered may include physicians' services, outpatient care, home health, durable medical equipment, ambulance, and preventive services. Preventive services include healthcare services to prevent illness (for example, vaccinations to prevent diseases like polio) or early detection tests and diagnostic tools, when treatment is most likely to be effective is collaboration between healthcare and service providers to aid in the process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet the comprehensive health needs of an individual or family. This is accomplished through communication and coordination of available resources to promote quality and cost-effective outcomes. The primary reason for this is the facilitation of care across the continuum of care for the patient. For example, a patient newly diagnosed with cancer may require surgery, laboratory services, chemotherapy, radiation, and counseling services. Case management helps navigate all the services and providers for the patient. Students also viewedWho typically reimburses healthcare providers by their services on quizlet?Third party payers reimburse providers for each case rather than for each service or per diem. is health care provided for free or at reduced prices to low income patients. sent to 3rd party payer, detailed list of fees or charges for each service.
What is the role of third party payers quizlet?Third-party payers manage or administer the pool of money from individuals who decide to join an insurance plan. 4. Third-party payers pay or underwrite coverage for health care for another entity.
What is the patient financial responsibility quizlet?a patient financial responsibility, which is due at the time of the office visit. a patient financial responsibility that the subscriber for the policy is contracted per year to pay toward his or her health care before the insurance policy reimburses the provider.
What is the term used to describe the payment made to maintain a health insurance policy How does the term safety in numbers apply to health insurance?Premium/ The amount that is paid to maintain health insurance whether you use it or not.
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Who is responsible for making payment for healthcare claims on behalf of the company quizlet?
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