CHAPTER 6
Reimbursement Methodologies
Objectives
After reading this chapter, you should be able to:
• Identify various managed care options
• Define common reimbursement terminology
• Classify HMO open- and closed-panel options
• Review the history of the BCBS system
• Examine features of various BCBS programs
• Determine eligibility criteria for the Medicare programs
• Determine the coverage and options available for Medicare subscribers
• Distinguish between the various Medicare plans
• Compare and contrast eligibility and enrollment for Medicaid and other state healthcare programs
• Differentiate between TRICARE and CHAMPVA eligibility and ...
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