The Healthcare Financing
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| Third-party payers | Any insurance company or government program that pays for healthcare services on your behalf
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| Prospective payment system (PPS) | Attempted to limit and standardize Medicare/Medicaid payments made
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| Diagnostic-related groups (DRG) | Defined the amount of reimbursement a facility received for admissions
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| Ambulatory patient classification (APC) | A new classification implemented in 2000 for payment to hospitals for outpatient services
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| International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) | Coding of diagnoses that groups together similar diseases and operations for reimbursement
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| Center for Medicare and Medicaid Services (CMS) | Was Health Care Financing Administration, is developing a new system called ICD-10
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| CMS Comon Procedure Coding System | A system that has 3 levels
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| Current Procedural Terminology (CPT) | Level 1 of CMS system that was developed in the 1960's by the American Medical Association for doctor's billing
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| Health Insurance Portability and Accountability Act (HIPAA) | Designed to improve the efficiency of the healthcare system by establishing standards for electronic data exchange
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| Entitlement programs | Include Medicare and Medicaid
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| Medicare | Enacted in 1965 to provide healthcare for individuals over 65 and the disabled
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| Medicaid | Enacted in 1965 to provide healthcare for the poor
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| Arizona Healthcare Cost Containment System (AHCCCS) | Is the state's form of Medicaid and providers must bid annually for contracts to serve the population, the people get to choose their healthcare provider
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| Health Maintenance Organizations (HMO) | Group practices that are reimbursed on a prepaid, negotiated, and discounted basis of admission
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| Preferred Provider Organizations (PPO) | Independent groups that offer services to employers at discounted rates in exchange for a steady supply of patients
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| Gatekeeper | A patient's advocate responsible for advising the patient on healthcare needs
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| Managed care organizations (MCO) | Has a contract with local providers to establish a complete network of services and reimburse providers based on the number of enrollees served
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Created by:
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