Copyright

Ch 5: Health Insurance & Reimbursement

About This Chapter

Study health insurance and reimbursement at your own pace with help from our intriguing chapter. The lessons and quizzes that make up this resource are written by professional instructors and accessible to you 24 hours a day on any mobile device or computer.

Health Insurance & Reimbursement - Chapter Summary

Our helpful chapter covers health insurance and reimbursement in an easy-to-follow and user-friendly format. Review subjects such as the types of health insurance, insurance reimbursement methods and healthcare capitation at your own pace. You're welcome to complete the entire chapter or only the lessons you know you need to work on. We've also included quizzes with each lesson and a test at the end of the chapter as self-assessment tools so you know you're on the right track. This chapter is designed to help you achieve these goals:

  • Discuss the key provisions of the Affordable Care and Patient Protection Act
  • Outline the concept of health insurance
  • Detail the types and roles of third-party payers
  • Describe the impact third-party payment systems have on healthcare organizations
  • Identify insurance reimbursement methods in health care
  • Define healthcare capitation and its risk
  • Understand the transition to value-based reimbursement
  • Outline diagnosis codes and their uses
  • Discuss the basics of the ICD-10-CM system
  • Explain current procedural terminology (CPT) and its uses

10 Lessons in Chapter 5: Health Insurance & Reimbursement
Test your knowledge with a 30-question chapter practice test
The Affordable Care & Patient Protection Act: Key Provisions

1. The Affordable Care & Patient Protection Act: Key Provisions

In this lesson, you'll learn about the Affordable Care Act and how it impacts individuals with and without health insurance. You'll also learn what benefits it provides to those with health insurance.

Health Insurance: Types & Concept

2. Health Insurance: Types & Concept

Did you know that there are an estimated 1 billion health insurance claims filed each year? Learn more about the different types of health insurance that are available in the United States.

Third-Party Payers: Types, Roles & Regulations

3. Third-Party Payers: Types, Roles & Regulations

Today's healthcare systems are facing challenges such as lower reimbursement for services. This lesson pinpoints the current third-party payment options, how reimbursement occurs, and regulatory concerns.

Impact of Third-Party Payment Systems on Healthcare Organizations

4. Impact of Third-Party Payment Systems on Healthcare Organizations

The U.S. healthcare system has several third-party payment systems that affect the finances of healthcare facilities. This lesson will define third-party payment systems and examine their effects on financial management of these facilities.

Insurance Reimbursement Methods in Health Care

5. Insurance Reimbursement Methods in Health Care

This lesson launches us into the world of provider reimbursements from insurance carriers. We'll explore factors that may affect payments as well as the reimbursement methods physician practices and healthcare organizations use today.

Healthcare Capitation: Definition, Incentives & Risk

6. Healthcare Capitation: Definition, Incentives & Risk

Capitation in healthcare is an alternative way for providers to be compensated for the care they give to their patients. This lesson will discuss the definition, incentives, and associated risks.

Transitioning to Value-Based Reimbursement

7. Transitioning to Value-Based Reimbursement

In this lesson, we'll define value-based reimbursement. You'll learn about the challenges in transitioning to this system and suggestions to manage change through the process.

What is a Diagnosis Code? - Definition & Uses

8. What is a Diagnosis Code? - Definition & Uses

When you think of lifesaving medical care, groundbreaking scientific research and critical legislation writing, you don't think about the one subject that links them all: medical coding. In this lesson, learn the vital importance of diagnosis codes.

What is the ICD-10-CM System? - Basics & Uses

9. What is the ICD-10-CM System? - Basics & Uses

The ICD-10-CM system is used to code medical records in healthcare settings. This lesson will discuss the basics of the ICD-10-CM system as well as some of its uses.

Current Procedural Terminology (CPT): Definition & Uses

10. Current Procedural Terminology (CPT): Definition & Uses

Current procedural terminology is a coding system that helps identify medical services and procedures. This lesson will discuss the definition and uses of current procedural terminology.

Chapter Practice Exam
Test your knowledge of this chapter with a 30 question practice chapter exam.
Not Taken
Practice Final Exam
Test your knowledge of the entire course with a 50 question practice final exam.
Not Taken

Earning College Credit

Did you know… We have over 200 college courses that prepare you to earn credit by exam that is accepted by over 1,500 colleges and universities. You can test out of the first two years of college and save thousands off your degree. Anyone can earn credit-by-exam regardless of age or education level.

To learn more, visit our Earning Credit Page

Transferring credit to the school of your choice

Not sure what college you want to attend yet? Study.com has thousands of articles about every imaginable degree, area of study and career path that can help you find the school that's right for you.

Support