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HIM Ch14 - Health Information Management Concepts...

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© 2010 Health Information Management: Concepts, Principles, and Practice Chapter 14: Reimbursement Methodologies
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© 2010 History of Healthcare Reimbursement Campaigns for national health insurance Development of prepaid health plans o UMLS Metathesaurus o Indemnity plans o Group health insurance o Major medical insurance
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© 2010 Commercial Insurance Private health insurance plans Employer-based self-insurance plans Blue Cross and Blue Shield plans
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© 2010 Government-Sponsored Programs Medicare Part A o Eligibility o Coverage Medicare Part B o Eligibility o Coverage Medicare Part C o Eligibility o Coverage
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© 2010 Government-Sponsored Programs (continued) Medicaid o Services o Programs of All-Inclusive Care for the Elderly o State Children’s Health Insurance Program TRICARE o Eligibility o Services
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© 2010 Government-Sponsored Programs (continued) CHAMPVA o Eligibility o Services Indian Health Service o Eligibility o Services Workers’ Compensation o Eligibility o Services
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© 2010 Managed Care Definition Goals Health maintenance organizations (HMOs) o Group model HMOs o Independent practice associations (IPAs) o
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