Question

Define claim. Define healthcare providers. Define third-party payers. What are two other names for Medicare? What is the new name for HCFA? What are the goals of Healthy People 2020? Name some changes that have been made to healthcare by the Affordable Care Act. For most healthcare expenses, what is the method of reimbursement? How is payment determined in a retrospective payment system? Describe how determination of payment is made in a prospective payment system

Answer 1

Claim
claim can be defined as request for payment or invoice submitted by healthcare provider or patients to the health insurer in regards to the servcies received.
Healthcare Provider
Healthcare providers can be refers to as facility where a clients or patients received a serveices related to personal health. it includes hospital, oprivate clinics and pharmacies stores.
Third Party Payor.
Third party payor are organizations either private or public that usually pays or insures medical or health expenses on behalf of a clients or beneficiaries. Also, they re-imburse or manage health care expenses.
The other two names for medicare were:
Hospital Insurance
Medical insurance
The new name for Health Care Finiancing Admonistration (HCFA) is Centers for Medicare and Medicaid Services (CMS).
Healthy People 2020 aims to reach four overarching goals:
 Achieve health equity, eliminate disparities, and improve the health of all groups.
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
Promote quality of life, healthy development, and healthy behaviors across all life stages.
Create social and physical environments that promote good health for all.
Changes that have been made to healthcare by the Affordable Care Act includes:
Supreme Court ruling on Medicaid expansion
Individual mandate delay
Reporting requirement delays
Cadillac tax delay
Extensions of grandmothered health plans
Employer mandate delays

Method of reimbursement
fee-for-service : this involves payment of many variations that exist and it is the greater the amount of services provided, the higher the amount of reimbursement.
capitation: it involves a fixed payment that is made to providers for each covered life and it is independent on the amount of services provided.
Retrospective Payment Method
Retrospective payment method is also known as fee-for service method. In this method, the insurance companies or other parties make payment after the services have being provided to the clients.
Prospective payment system
Prospective payment system is the medicare payment made based on the fixed amount or predetermined amount. it is payment made on a particular services.