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