Question 1

The party that assumes the risk of paying some or all of the cost of providing health care services in return for the payment of a premium by or on behalf of the individual is the ___________.

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Question 2

The process of determining the most accurate DRG payment is ___________.

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Question 3

The exchange of cash for professional services rendered, at a rate less than the normal fee for the service, is called ___________.

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Question 4

Prospective payment for acute care is based on ____________.

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Question 5

The exchange of cash, goods, or services for professional services rendered at a specific rate, typically determined by the provider, and associated with specific activities (such as a physical examination) is called __________.

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Question 6

The coordination of the patient's care and services, including reimbursement considerations, is characteristic of ___________.

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Question 7

ICD-10-CM diagnosis and procedures codes are used to derive the DRG by following the flowchart in a ___________.

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Question 8

The potential exposure to loss, financial expenditure, and/or other undesirable events is called _________.

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Question 9

Any of several reimbursement methods that pay an amount predetermined by the payer, based of the diagnosis, procedures, and other factors (depending on setting) rather than actual, current resources expended by the provider, is called ________.

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Question 10

To standardize and facilitate accurate billing, health care facilities maintain a database of all potential services to a patient called a _________.

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Question 11

The application to an insurance company for reimbursement is called the ______________.

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Question 12

The systematic reimbursement to a health care provider based on the number of patients contractually in the physician's care, regardless of diagnoses or services rendered, is called ___________.

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Question 13

The blending of the insurance and provider roles in health care delivery is characteristic of _________.

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Question 14

A ______________ is a type of third party payer arrangement in which an individual is responsible for a percentage of the amount owed to the provider.

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Question 15

The systematic collection of specific charges for services rendered to a patient is called ___________.

Accepted Answer

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Question 16

Medicare uses __________ to process its claims and reimbursements.

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Question 17

Payments calculated based on the number of days are called ____________.

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Question 18

The process of evaluating medical interventions against established criteria, based on the patient's known or tentative diagnosis, is called ____________.

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Question 19

CMS's prospective payment system for hospital-based ambulatory care is based on ___________.

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Question 20

Medicare is a federal funded program available to those age 65 and older and those on permanent disability. However, there are many different programs that Medicare offers that are called Parts. How many parts does Medicare have and what services are offered? What does the federal program pay for and what is the patient responsible for?

Accepted Answer

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Quiz 7: Reimbursement