CHAPTER 1: HEALTHCARE
REIMBURSEMENT AND REVENUE
CYCLE MANAGEMENT QUESTIONS
AND ANSWERS
Beneficiary - ANSWER-An individual who is eligible for benefits from a health plan.
Guarantor - ANSWER-Person who is responsible for paying the bill for healthcare
services.
Insurance - ANSWER-Reduction of a person's exposure to the risk of loss by having
another party assume the risk.
Policyholder - ANSWER-An individual who purchases health insurance coverage.
Premium - ANSWER-Amount of money that must be periodically paid to a health
insurance company in return for healthcare coverage.
Reimbursement - ANSWER-The amount paid to a healthcare provider for services
provided to a patient.
Risk pool - ANSWER-Group of individuals or entities who have similar risk of loss.
Third-party payer - ANSWER-An insurance company or health agency that pays the
provider for the care or services provided to the patient.
Integrated Revenue Cycle - ANSWER-The coordination of all revenue cycle activities,
facility, and physician, under a single leadership and team structure.
National Health Service (Beveridge) Model - ANSWER-Method of health systems
financing in which there is a single-payer that owns the healthcare facilities pays the
healthcare providers and is funded by a country's general revenues from taxes. It is a
single-payer health system. For example, the UK uses this system and is financed by
the country's general revenue.
Private Health Insurance Model - ANSWER-Many competing private health insurance
companies exist, collect premiums to create a pool of money, and pay for health claims
of their subscribers. The insurance company determines the contribution, and this
contribution is not based on the employee's income.
REIMBURSEMENT AND REVENUE
CYCLE MANAGEMENT QUESTIONS
AND ANSWERS
Beneficiary - ANSWER-An individual who is eligible for benefits from a health plan.
Guarantor - ANSWER-Person who is responsible for paying the bill for healthcare
services.
Insurance - ANSWER-Reduction of a person's exposure to the risk of loss by having
another party assume the risk.
Policyholder - ANSWER-An individual who purchases health insurance coverage.
Premium - ANSWER-Amount of money that must be periodically paid to a health
insurance company in return for healthcare coverage.
Reimbursement - ANSWER-The amount paid to a healthcare provider for services
provided to a patient.
Risk pool - ANSWER-Group of individuals or entities who have similar risk of loss.
Third-party payer - ANSWER-An insurance company or health agency that pays the
provider for the care or services provided to the patient.
Integrated Revenue Cycle - ANSWER-The coordination of all revenue cycle activities,
facility, and physician, under a single leadership and team structure.
National Health Service (Beveridge) Model - ANSWER-Method of health systems
financing in which there is a single-payer that owns the healthcare facilities pays the
healthcare providers and is funded by a country's general revenues from taxes. It is a
single-payer health system. For example, the UK uses this system and is financed by
the country's general revenue.
Private Health Insurance Model - ANSWER-Many competing private health insurance
companies exist, collect premiums to create a pool of money, and pay for health claims
of their subscribers. The insurance company determines the contribution, and this
contribution is not based on the employee's income.
