Chapter 4

FEHBP federal employees health benefit program

and employer sponsored health insurance program available to employees of the federal government

workers compensation

a program that provides health care benefits two employees who are injured on the job

Medicare

a federal program that Pays healthcare costs for the elderly permanently disabled and those with end-stage renal disease

CMS center for Medicare and Medicaid services

the federal agency that administers the Medicare and Medicaid programs

self-referral /kickbacks

health care providers are prohibited under federal law from referring patients 2 Laboratories or other health services in which they have a financial interest. Stark law 1

TRICARE

A Health insurance program offered by the department of Defense to military personnel

Medicare A

pays for inpatient Hospital services critical access hospitals and skilled nursing facilities

Medicare B

Physician Services, outpatient hospital care, and some services

SCHTP

Federal program that targets low-income children whose parents do not qualify for Medicaid and unable for private insurance

Medicaid funding

funded by taxpayer income tax payments to the government's General Revenue

Medicaid spending distribution

state uses FMAP

medical coding

offices use this to determine how much to charge a patient

upcoding

submitting a claim they never did or a different code at a higher rate

OPM office of personnel management

human resources department of federal government

Medicare eligibility

has to be 65 years or older, permanently disabled or end stage renal disease

what is the basic or primary purpose of workers compensation

provides health care benefits to employees who are injured and eliminate the need for an employee to sue employer