Chapter 4 Flashcards
1
Q
The basic unit of a healthcare business is made of (3)?
A
- a patient
- an insurer
- a healthcare provider
2
Q
What does Medicare Part A cover?
A
- inpatient hospital services, short-term nursing home care, and home based services.
- no cost
3
Q
What does Medicare Part B cover?
A
- outpatient health services (PT, diagnostic tests, dr. visits)
- voluntary, has a cost/fee
4
Q
The textbook defines medical necessity as?
A
- services and treatments that are considered necessary and reasonable according to evidence-based standards of care.
5
Q
How is Medicaid different than Medicare?
A
- eligibility is not age related, rather limited to people below a certain income/assets level
- each state manages it’s own program
- both medicaid and medicare started in 1965
6
Q
The patient protection and affordable care act require what 10 benefits to be included in any health insurance plan?
A
- ambulatory pt services
- emergency services
- hospitalization
- maternity/newborn care
- mental health and substance use disorder
- prescription drugs
- rehab and habilitation services and devices
- laboratory services
- preventive and wellness services and chronic disease management
- pediatric services including oral and vision care
