Question

204%281%29.docx BIVAA EEE Chapter Assignment 4 1. Define prospective reimbursement for health services. 2. Define coinsurance for health services. 3. Define (means-tested program) for health services. 4. Define (benefit period for Medicare Part A) health services. 5. Define retrospective reimbursement for health services. 6. Identify the four commonly used HMO Models 7. Identify the growth strategy in which a health care delivery organization extends its core product or service 8. Define integrated delivery system (IDS). 9. Define accountable care organization (ACO). 10. MCOs use three main types of payment arrangements with providers. Identify the three main types of payment arrangements. SAMSUNG

Answer 1

1. Prospective reimbursement is also known as Prospective Payment System , Where reimbursement is paid based on the fixed payment amount by Medicare services.

2. Co Insurance is a process where a person can have a choice of sharing some percentage of the payment of health care bills with the insurance group.

3. A Mean tested programme is a determination of finding whether a person is eligible for the Government services provided.

4. The benefit period is one of the original Medicare programme which actually measures the length of your stay in Skilled Nursing Facility.This actually starts with the entry of the person in to SNF and ends in 60 days of which a person did not receive any care covered under SNF and Medicare.

5. Retrospective reimbursement is a person can be paid according to the fixed determined amounts rather than the actual bills that were paid in the hospital.

6. Four commonly used HMO Models :

HMO is an health insurance plan which limits the coverage from doctors who work in contract with HMO.

• Staff
• Group
• Network
• Direct contract

7. Growth strategy of health care delivery is the Physician network and Physician talents.

8. Integrated Delivery system is a network with a goal of providing logical services to the unorganized group of people.

9.Accountable Care Organization is a health care organization that ties up with the reimbursement metrics of quality and cost care reductions.

10. Capitation

Discounted fees

  Salaries.