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Chapter 6 - Reimbursement Methodologies

by Angela Allen
Horizontales
an individual that purchases healthcare insurance coverage
provides hospitalization insurance
used to detect and correct improper payments in Medicare fee for service program
prepaid health plans
healthcare program for dependents and survivors of totally disabled veterans
voluntary supplemental medical insurance
assigning diagnosis code for the purpose of obtaining higher payment
process of receiving approval from healthcare insurance company
using multiple codes rather than an appropriate one code to describe a procedure
creates a hospital's case mix index
payment for service included in payment for other services
pays for healthcare services provided to the low income
healthcare services provided to people of 65 years and older
effective means to communicate with physicians for clarification of data
Verticales
list the individual charges for every element in providing service
stands for State Children's Health Insurance Program
condition arises during hospitalization
external or internal reviews to identify variations from established baseline
multiple surgical procedures furnished during the same operative session
intentional and mistaken misrepresentation of reimbursement claims
the amount the insured pays as requirement of the insurance policy
the amount the insured pays before the insurer assumes liability
healthcare program for active-duty service members
abbrv for Programs of All-Inclusive Care for the Elderly
itemized statement of healthcare services and their cost provided