HCR 202 Week 3 Government Payors Worksheet

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HCR 202 Week 3 Government Payors Worksheet
Complete the University of Phoenix Material: Government Payors Worksheet.

Click the Assignment Files tab to submit your assignment.

Government Payors Worksheet


Complete Parts A and B of this worksheet.                                                                                            


References: Ch. 9, 10, 11 Medical Insurance


Part A


Fill in the missing information by completing the table.


Identify the Payor Type, eligibility and coverage for Medicare programs, Medicaid, CHAMPVA, and Tricare.


Payor type
Patient responsibility
Medicare Part A
First 60 days responsibility is the annual deductible.


For days 61–90 there is a per-day copay and another per-day copay after days 91–150.


Beyond day 150 Medicare Part A does not make a payment.
Individuals entitled to Medicare Part A are automatically qualified to enroll in Part B.


Needs to be a U.S. citizen and over the age of 65 (voluntary program)
Physician services, outpatient hospital services, medical equipment, and other supplies and services
Private health insurance companies contract with The Centers for Medicare and Medicaid to offer Medicare Advantage plans.
Medicare Part D
Medicare prescription drug plan (private insurance plan)
Categorically needy
Administered at a State Level- each state determine coverage and sets the payment rates.


Services include hospital, outpatient, physician services, laboratory, radiology- some States include Prescription services, vision care, vision, clinic services, home and community based care.
Some may include a spend down program prior to reimbursement


Individuals/families may be required to spend a portion of income or resources on health care which is similar to a deductible.
Coinsurance for nonparticipating providers


Annual enrollment and copays for retirees/family
Government health insurance program for families of veterans with 100% services related to disability
Includes most all treatment with the exception of unnecessary services and supplies


Does not include experimental treatment, custodial care, or dental care

Part B


Write 50- to 150-word responses to the following questions. Use your own words and provide examples to support your answers.


Cite any outside sources. For additional information on how to properly cite your sources see the Reference and Citation Generator resource in the Center for Writing Excellence.


1.     Why is it important to understand the guidelines for timely claim filing from the date of treatment or discharge?


2.     Explain why it is important to understand the different payor coverage and patient responsibility?
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