HIM Ch14 - © 2010 Health Information Management Concepts...

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Unformatted text preview: © 2010 Health Information Management: Concepts, Principles, and Practice Chapter 14: Reimbursement Methodologies © 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 © 2010 Commercial Insurance • Private health insurance plans • Employer-based self-insurance plans • Blue Cross and Blue Shield plans © 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 © 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 © 2010 Government-Sponsored Programs (continued) • CHAMPVA o Eligibility o Services • Indian Health Service o Eligibility o Services • Workers’ Compensation o Eligibility o Services © 2010 Managed Care • Definition • Goals • Health maintenance organizations (HMOs) o Group model HMOs o Independent practice associations (IPAs)...
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This note was uploaded on 10/07/2011 for the course HIM 410 taught by Professor Loishitchcock during the Fall '11 term at Ill. Chicago.

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HIM Ch14 - © 2010 Health Information Management Concepts...

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