Chapter 3_workbook exercises (1)
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Feb 20, 2024
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Principles of Healthcare
Reimbursement and
Revenue Cycle
Management
Eighth Edition
Student Workbook
Chapter 3
Government-Sponsored Healthcare
Programs
Complete the following exercises 1 through 3. 1.
Key Term Matching (8 points)
Match the key term to the correct definition.
Key Term
Answe
r
Definition
a. Medicare Part A
c.
Medicare Advantage managed care plan
b. Medicare Part B
f.
Medicare supplemental insurance
c. Medicare Part C
h.
Ensures that civilian employees of the federal government are provided medical, death, and income benefits for work-related injuries and illnesses
d. Medicare Part D
e.
Enrollee in Medicare
e. Beneficiary
a.
Insurance for acute-care hospital inpatient admissions
f. Medigap
d.
Medicare prescription drug benefit
g. Social Security Act
b.
Insurance for services and care provided by a physician
h. Federal Employees’ Compensation Act of 1916
g.
Law that outlines the Medicare and Medicaid programs
2.
Communicating Government-Sponsored Healthcare Programs (
7 points
)
Government-sponsored healthcare programs discussed in chapter 3 are provided in the following table. For each program, describe the program’s intentusing nontechnical terminology.
Government Sponsored Program
Description
Children’s Health Insurance Program (CHIP)
A state-federal partnership that provides health coverage to children without health insurance and targets low-income families. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
Offers health coverage to spouse/widows and children of veterans who were either permanently disabled due to a service-connected disability, died of this disability, had this disability at the time of death, or died on active duty not due to misconduct.
Indian Health Services (IHS)
Provided healthcare and promotes health to American Indians and
Alaskan Native people, communities, and cultures.
Program of All-Inclusive Care for the Elderly (PACE)
A joint Medicare/Medicaid plan for the older adult population. It allows elderly to live in their own homes while enhancing their quality of life and provides support.
TRICARE
Provides healthcare to active-duty or retired members of any 8 uniformed services of the U.S. military. Coverage is also provided for members’ families
and survivors.
Veterans Health Administration
Healthcare coverage for veterans that
served active military and were not separated under dishonorable discharge. This also covers current or former members of the Reserves or National Guard called to active duty and served a full period in active duty.
Workers’ Compensation
Provided to most employees to cover healthcare costs and loss of pay that results from a work-related injury or illness.
Intermediate Exercises
3.
Medicare Cost Sharing (5 points)
Using tables3.1 and 3.2 from the textbook
,calculate the cost sharing amount for a beneficiary in the following scenarios.
Scenario A
This is the third inpatient admission for Indie this year. Indie satisfied his deductible during the first admission. The length of stay for the first admission was 28 days. The second admission was for 25 days. The third admission was 19 days.
What is the cost sharing amount Indie owes for the third inpatient admission? $4,800
Scenario B
Chloe’s primary care physician sent her to Memorial Hospital laboratory to get some bloodwork. She has already met her outpatient deductible for the year.
What is the cost sharing amount for Chloe for the laboratory services? Nothing ($0)
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Scenario C
Raj is receiving home health services three times per week. The HHA approved two pieces of durable medical equipment (DME), a lift chair and a walker. The total allowable charge for the two DME items is $650. The total allowable charges for home health services for the
most recent 30-day episode of care is $3,435. Raj has already met his inpatient and outpatient deductible for the year.
What is the cost sharing amount for the home health services
? Nothing ($0)
What is the cost sharing amount for the DME
? $130
Scenario D
Savannah saw her primary care physician in January for a sinus infection. The total allowed charges for the visit were $125. This was the first healthcare encounter for Savannah this year.
What is the cost sharing amount for the physician visit? $125 towards the deductible