Quiz Review Essay

1177 WordsAug 14, 20135 Pages
1. Who are the first, second, and third parties in healthcare situations? The first party is the patient himself or herself or the person, such as a parent, responsible for the patient’s health bill. The second party, often called providers is the physician, clinic, hospital, nursing home, or the healthcare entity rendering the care. The third party is the payer, and uninvolved insurance company or health agency that pays the physician, clinic, or other secondary party provider for the care or services rendered to the first party. 2. Compare the UCR and the CPR payment systems. The usual, customary, and reasonable (UCR) is one version of discounted fee-for-service payment method. The UCR is a type of fee-for-service payment method in…show more content…
6. How do third-party payers set per diem payment rates? The insurance companies would compare historical data. Without historical data they would consider the costs, volumes of service, patient severity of illnesses, and the patients’ lengths of stay. 7. Describe the major benefits of episode-of-care reimbursement according to its advocates and the major concerns about episode-of-care reimbursement expressed by his critics. The benefits of episode of care reimbursement are the saving costs from unnecessary procedures, duplicating laboratory work, and loss reports. The concerns are denying, delaying, and or substituting diagnostic, laboratory, test and treatments for less quality procedures. 8. Why is the federal government a dominant player in the healthcare sector? The healthcare sector of the federal government covers programs for senior citizens, people with disabilities through Medicare, two thirds of the cost of joint state-federal Medicaid programs, which provides health reimbursement services for low income persons and families, and includes healthcare services for a variety of populaces including active duty and retired military personnel among others. 9. Why is the constant trend of increased national spending on healthcare a concern? Because money is a limited resource, infrastructures will have less money due to
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