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Reimbursement Methodologies

Teacher: Nanci Cross
Across
The practice of assigning diagnostic or procedural codes that represent higher payment rates than the codes that actually reflect the services provided to patients.
This diagnosis is the disease or condition that was present on admission and was the main or principal reason for admission.
A financial management form that contains information about the organization's charges for the healthcare services it provides to patients
Health insurance coverage provided in the form of cash payments to patients or providers
A type of HMO model which contract for services with one or more multispecialty group practices
Organization contracted to detect and correct improper payments to Medicare
A 3 or 4 digit number in the chargemaster that totals all items and their charges for printing on the form used for Medicare billing
Private commercial insurance plans are financed through the payment of ___.
Down
A type of insurance which can help pay some of the healthcare costs like deductibles and coinsurance that Medicare doesn't cover.
Sometimes referred to as the Children's Health Insurance Program
The process of establishing an organizational culture that promotes the prevention and resolution of instances of conduct that do not conform to federal, state, or private payer healthcare program requirements.
Administers Medicare Part A & B as of 2011
Consists of 4 parts
The federal healthcare program that provides coverage for the dependents of armed forces personnel and for retirees receiving care outside military treatment facilities in which the federal government pays a percentage of the cost.
Health care for low income individuals - administered partially by the state.
Omnibus Budget Reconciliation Act