HIMS 5620 EXAM 1 | QUESTIONS AND ANSWERS |
LATEST UPDATE | WITH COMPLETE SOLUTION
reimbursement Answer - amount paid to a healthcare provider for services
provided to a patient
revenue cycle Answer - regular set of tasks and activities that produces
reimbursement (revenue)
revenue cycle management (RCM) Answer - the supervisor of all the
administrative and clinical functions that contribute to the capture,
management, and collection of patient service reimbursement
insurance Answer - a system of reducing a person's exposure to risk of loss by
having another party, an insurance company, assume the risk
three national models for delivering healthcare services Answer - social
insurance, national health insurance, private health insurance
social insurance model (Bismark model) Answer - universal healthcare
coverage for a set of benefits defined by the government, which may include
preventative and primary care, hospitalization, mental health benefits, and
prescription drugs
every worker and employer must contribute to sickness funds who redistribute
the money per government regulations (form of social security)
, the amount contributed is based on income
national health service model (Beveridge model) Answer - single-payer health
system
one entity, can be the government or a government-run organization acts as an
administrator of a single insurance pool, collects all health fees and pays all
health costs for an entire population
financed by country's revenue that come from taxes based on income
private health insurance model Answer - collect premiums to create a pool of
money, used to pay health claims
workers and employers contribute to pool, insurance company determines
contribution which is NOT based on income
third-party payer Answer - an insurance company or health agency that pays
the physician, clinic, or other provider for the care or services rendered to the
patient
premium Answer - the amount of money that a policyholder or beneficiary
must periodically pay an insurance company in return for healthcare coverage
risk pool Answer - group of individual entities, such s individuals, employers, or
associations whose healthcare costs are combined for evaluating financial
history and estimating future costs
LATEST UPDATE | WITH COMPLETE SOLUTION
reimbursement Answer - amount paid to a healthcare provider for services
provided to a patient
revenue cycle Answer - regular set of tasks and activities that produces
reimbursement (revenue)
revenue cycle management (RCM) Answer - the supervisor of all the
administrative and clinical functions that contribute to the capture,
management, and collection of patient service reimbursement
insurance Answer - a system of reducing a person's exposure to risk of loss by
having another party, an insurance company, assume the risk
three national models for delivering healthcare services Answer - social
insurance, national health insurance, private health insurance
social insurance model (Bismark model) Answer - universal healthcare
coverage for a set of benefits defined by the government, which may include
preventative and primary care, hospitalization, mental health benefits, and
prescription drugs
every worker and employer must contribute to sickness funds who redistribute
the money per government regulations (form of social security)
, the amount contributed is based on income
national health service model (Beveridge model) Answer - single-payer health
system
one entity, can be the government or a government-run organization acts as an
administrator of a single insurance pool, collects all health fees and pays all
health costs for an entire population
financed by country's revenue that come from taxes based on income
private health insurance model Answer - collect premiums to create a pool of
money, used to pay health claims
workers and employers contribute to pool, insurance company determines
contribution which is NOT based on income
third-party payer Answer - an insurance company or health agency that pays
the physician, clinic, or other provider for the care or services rendered to the
patient
premium Answer - the amount of money that a policyholder or beneficiary
must periodically pay an insurance company in return for healthcare coverage
risk pool Answer - group of individual entities, such s individuals, employers, or
associations whose healthcare costs are combined for evaluating financial
history and estimating future costs
