CHAPTER 6

Reimbursement Methodologies

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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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