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  • In Class Assignment - Health Care Payment Systems and Abbreviations-1

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    Leslie Rognstad
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    The document provides information on different health care payment systems in the United States including Medicare, Medicaid, TRICARE, and CHIP. It outlines the payment methods, covered occupational therapy services, and eligibility qualifications for each system. An accompanying table defines common reimbursement abbreviations and acronyms used in health care billing and documentation.

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    Overview of Health Care Payment Systems and common medical abbreviations

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    In Class Assignment_Health Care Payment Systems and Abbreviations-1

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    The document provides information on different health care payment systems in the United States including Medicare, Medicaid, TRICARE, and CHIP. It outlines the payment methods, covered occupational therapy services, and eligibility qualifications for each system. An accompanying table defines common reimbursement abbreviations and acronyms used in health care billing and documentation.

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    29 views2 pages

    In Class Assignment - Health Care Payment Systems and Abbreviations-1

    Uploaded by

    Leslie Rognstad
    The document provides information on different health care payment systems in the United States including Medicare, Medicaid, TRICARE, and CHIP. It outlines the payment methods, covered occupational therapy services, and eligibility qualifications for each system. An accompanying table defines common reimbursement abbreviations and acronyms used in health care billing and documentation.

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    © All Rights Reserved
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    of 2

    OTHA 2335 2/1/2023

    2335 OTHA Health Care Management in Occupational Therapy

    In-Class Assignment: Health Care Payment Systems

    Payment Source State or Federal Fee Payment System OT Services Covered? Program Qualification

    People over 65, people


    less than 65 with
    Fee-for-service, PPS,
    Medicare Federal Yes certain disabilities,
    Capitated
    people of all ages with
    End Stage Renal Disease

    Low-income, limited-
    resource families,
    Joint Federal and qualified pregnant
    Medicaid Capitated Yes, in Texas
    State women and children,
    individuals on social
    security income

    Active duty, retired


    TRIcare Fee for service,
    Federal Yes military, and eligible
    Managed care
    family less than 65

    Provides low-cost
    coverage to children in
    families
    that earn too much
    CHIP State Capitated Yes, in Texas
    money to qualify for
    Medicaid and
    too low for private
    coverage
    OTHA 2335 2/1/2023

    2335 OTHA Health Care Management in Occupational Therapy

    In-Class Assignment: Reimbursement Abbreviations and Acronyms

    BBA IRF
    Bipartisan Budget Act of 2018 Inpatient Rehabilitation Facility
    BCBS MDS
    Blue Cross Blue Shield Medical Data System
    CMS MPFS
    Centers for Medicare and Medicaid Services Medicare Physician Fee Schedule
    CPT OASIS
    Current Procedural Terminology Outcome and Assessment Information Set
    CMG OPPS
    Case-Mix Group Outpatient Prospective Payment System
    CORF OTPP
    Comprehensive Outpatient Rehabilitation Facility Oriented to Time Place and Person
    DME PDPM
    Durable Medical Equipment Patient Driven Payment Model
    DOD PDGM
    Department of Defense Patient Driven Groupings Model
    DRG PACE
    Diagnosis Related Group Program of all-inclusive Care for the Elderly
    DSM-V PAI
    Diagnostic and Statistical Manual of Mental Disorders, Patient Assessment Instrument
    5th Edition
    EPSDT PFFS
    Early and Periodic Screening, Diagnosis, and Treatment Private Fee-for-Service
    ERISA POS
    Employee Retirement Income Security Act Point of Service
    HCPAC PPO
    Health Care Professional Advisory Committee Preferred Provider Organization
    HCPCS PPS
    Healthcare Common Procedure Coding System Prospective Payment System
    HHA RAI
    Home Health Agency Resident Assessment Instrument
    HIPPAA RAP
    Health Insurance Portability and Accountability Act Resident Assessment Protocol
    HMO RBRVS
    Health Maintenance Organization Resource Based Relative Value Scale
    ICD-10-CM RUG
    International Classification of Diseases, 10th Revision, Resource utilization groups
    Clinical Modification
    IDEA RVU
    Individuals with Disabilities Education Act Relative value unit
    IEP SCHIP
    Individualized Education Program State Children's Health Insurance Program

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