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Principles of Healthcare Reimbursement, Chp 1, Part 1 Questions and Correct Answers

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The US healthcare system is inherently complex because it is actually multiple subsystems rather than a single system Insurance a system of reducing a person's exposure to risk of loss by having another party (insurance company or insurer) assumes the risk Risk pool group of persons with similar ...

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the us healthcare system is inherently complex bec
insurance a system of reducing a persons exposur

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Principles of Healthcare
Reimbursement, Chp 1, Part 1 Questions
and Correct Answers
The US healthcare system is inherently complex because ✅it is actually multiple
subsystems rather than a single system

Insurance ✅a system of reducing a person's exposure to risk of loss by having another
party (insurance company or insurer) assumes the risk

Risk pool ✅group of persons with similar risks of loss

Risk ✅In healthcare, is the potential that a person will get sick or require health
services and will incur bills (costs) associated with his or her treatment or services.

Dependent/family coverage ✅Health insurance for spouses, children, or both

Reimbursement ✅being repaid or compensated for expenses already incurred or, as in
the case of health-care, for services that have already been provided (physicians and
clinics must seek to be paid back for services that they have already provided)

Party ✅an entity that receives, renders, or pays for health services

First party ✅is the patient himself or herself or the person, such as a parent,
responsible for the patient's health bill

Second party ✅the physician, clinic, hospital, nursing home, or other healthcare entity
rendering the care. These second parties are often called providers because they
provide healthcare

Third party ✅the payer, an uninvolved insurance company or health agency that pays
the physician, clinic, or other second-party provider for the care or services rendered to
the first party (patient)
Examples of third-party payers are health insurance companies, workers'
compensation, and Medicare.

Unit of payment ✅Element that is the basis of payment; ranges in aggregation from
single service such as a laboratory test, to an entire clinic visit. To an episode of care, to
hospitalization, and finally, to an entire population.

Time orientation ✅is retrospective versus prospective

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