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Related Flashcards
Cards In This Set
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A prospective hospital claims reimbursement system currently utilized by the fed gov
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All Patient Diagnosis Related Groups Assignment of Benefits (APDRG)
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A system of averagaing and bundling using CPT, HCPCS, and revenue codes submitted for payment.
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Ambulatory Payment Classification (APC)
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The maxium dollar amount set by a MCO that limits the total amount the plan must pay for all health care services provided to a subscriber in a year.
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Annual Maximum Benefit Amount Deductible
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Written authorization from the policy holder for their insurance company to pay benefits directly to the care provider.
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Assignment of Benefits
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A health insurance pla in which patients may selet any doctor or hospital and providers bill the patient or the insurance company their normal fees for their services.
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Indemnity
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Independent, not-for-profit organization and the nation's oldest and largest standards setting and healthcare accrediting body.
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JCAHO (Joint Commission)
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The maximum amount of benefit paid by the insurance company per isured. Once this lifetime maximum has been exhaused, the insruance compnay will not pay any benefits.
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Lifetime Maximum
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Medicare Part A coverage that entitles the beneficary to sixy days of inpatient coverage beyond the coinsurance day benefit period.
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Lieftime Reserve Days (LRD)
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An Association of the insurance commissioners of the states and territories.
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National Association of Insurance Commissioners (NAIC)
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Established uniform standards for billing with CPT and HCPCS codes.
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National Correct Coding Initiative (NAIC)
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A federal law which mandates that coverage for hospital stays for childbirth generally cannot be less than 48 hours for normal deliveries or 96 hours for cesarean births
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Newborns' and Mothers' Health Protection Act (NMHPA)
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The Office of the Inspector General, Department of Health and Human Services
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Office of the Inspector General (OIG)
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Many fedreal regulations that impact healthcare financing are the result of budget legislation.
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Omnibus Budget Reconciliation Act (OBRA)
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Active total care of patients who have advanced illnesses no longer amenable to curative treatment. Control of symptoms
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Palliative Care
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Negotiated daily payment for delivery of hospital services provided ( room and board)
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Per Diem
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