Ch. 7 Third party reimbursement

Question	Answer
Third-party Reimbursement	The process by which health care practitioners receive reimbursement from a policyholder's insurance company for services they perform.
Third Party	A medical vendor who has no binding interest in a particular contract (insurance policy). -Primary mechanism of paying medical services in US
TYPES OF THIRD-PARTY PAYERS	Fee-for-service plan Health maintenacne organizations Preferred provider organizations Exclusive provider organizations Point-of-service plan Government sponsored program
Fee-for-service plan	Patients are free to go to a medical provider of their choice. (Known as an indemnity plan)
Health maintenance organizations (HMO)s	Provide participating health care practitioners with a fixed fee for services rendered to members. -Capitaiton system usually determines fees.
Preferred provider organizations (PPOs)	Similar to HMOs, but allow for greater choice of health care providers and pay medical vendors one fee-for-service.
Exclusive provider organizations (EOP)	Participants enrolled in these can recieve benefits only from contracting medical providers.
Point-of-service plan (POS)	Similar to PPO, except POS plans assign primary care physicians who coordinating patient care.
Government sponsored programs	Provide coverage for: -the elderly (Medicare) -the needy (Medicaid) -members of armed forces (TRICARE)

Resource summary

	Created by Tamara Jacob over 8 years ago