chptr 1 healthcare in the US

Question 1

Accountable care organizations

ACOs

Answer 1

groups of doctors, hospitals,and other healthcare providers that come together voluntarily to give high-quality care using a fixed payment model; they work collaboratively and accept collective accountability for costs and the quality of care

Question 2

accreditation

Answer 2

Voluntary assessment by an accrediting agency that proves a healthcare facility exceeds the minimum requirements set by licensing agencies

Question 3

Affordable care act (ACA)

Answer 3

healthcare reform with the goal of improving quality of care and affordable healthcare coverage through health insurance exchange , new payment models, initiatives to improve-care and the expansion of Medicaid to millions of low income citizens; provides healthcare consumers with stability and flexibility of healthcare coverage

Question 4

american college of surgeons (ACS)

Answer 4

A professional association of physicians specializing in surgery, founded in 1913, with the purpose of improving quality of care by setting patient care and surgical education standards

Question 5

American Hospital Association (AHA)

Answer 5

a professionals association of hospitals with the purpose of improving medical care through advocacy, education of healthcare leaders, and tracking of trending healthcare related issues

Question 6

american medical association (AMA)

Answer 6

a professional association of physicians founded in 1847 with the purpose of developing standards for medical education , improving public health, establishing medical ethics, and advancing the study of science

Question 7

centers for medicare and medicaid services (CMS)

Answer 7

formerly known as the health care financing administration (HCFA), CMS manages medicare and medicaid claims and regulates medicare and medicaid programs

Question 8

Clinician decision support (CDS)

Answer 8

case-specific computerized alerts, clinical guidelines, and current resources regarding diagnosis and treatment options, based on the data found in individual patient records

Question 9

conditions of participation (CoP)

Answer 9

Regulations that healthcare facilities and providers must meet in order to receive reimbursement from medicare and medicaid

Question 10

Deficit Reduction Act

Answer 10

Legislation passed with the intent to reduce growth in medicare and medicaid spending and decrease the number of fraudulent medicare and medicaid claims

Question 11

department of health and human services (HHS)

Answer 11

the federal agency responsible for ensuring the provision of vital human services and health protection to americans

Question 12

diagnosis related group (DRG)

Answer 12

a system that classifies orients into groups based on a patients principal and secondary diagnoses, procedures performed , and other factors and determines the amount reimbursed to hospital by medicare, medicaid, and other third party payers.

Question 13

evidence based medicine (EBM)

Answer 13

diagnostic and treatment protocols based on proven research and documented best practice

Question 14

fee for service

Answer 14

billing for healthcare services after the services have been provided (retrospectively) according to the facility’s or offices actual fees for each service

Question 15

Healthcare facilities accreditation program (HFAP)

Answer 15

a voluntary accreditation program used by the american osteopathic association, which, like the joint commission, holds deemed status for medicare

Question 16

health information technology

Answer 16

the framework on which health information is collected, stored, exchanged, and reported

Question 17

health information technology for economic and clinical health act (HITECH)

Answer 17

legislation resulting from the ARRA that provides incentives to providers and hospitals that adopt or upgrade existing electronic health record (ehr) systems and associated technologies and use them in specified ways

Question 18

health insurance portability and accountability act (HIPPA)

Answer 18

a law consisting of five rules- privacy, security, data sets, and electronic transaction standards, administrative simplification and enforcement and compliance; it impacted healthcare in general and the health information profession in particular more so than any piece of legislation since medicare and medicaid

Question 19

Hill-Burton Act

Answer 19

legislation that supplied funding for the modernization of existing hospitals and the building of new ones, in exchange for which hospitals provided care at a reduced rate or for free to patients who did not have the ability to pay.

Question 20

Independent Practice Association (IPA)

Answer 20

A group of physicians that contracts with a managed care organization to provide care at a pre-determined, pre-negotiated (often reduced) rate.

Question 21

Informed consent

Answer 21

Patient consent required for invasive surgical procedures and any treatment or procedure that carries a risk to the patient; informed consent provides explanation of the procedure/treatment to be performed and the reason for it; in other words, the risks and benefits of the procedure/treatment , alternatives to the procedure/treatment and their risks and benefits, and the name(s) of the healthcare provider(s) performing the procedure/treatment.

Question 22

Licensure

Answer 22

Regulations regarding the minimum requirements to practice medicine or provide medical services; they vary from state to state.

Question 23

Managed care insurance plans

Answer 23

Insurance plans that promote quality, cost effective healthcare through the monitoring of patients, preventive care, and performance measures

Question 24

Meaningful Use

Answer 24

the sections of HITECH meant to increase the effective use of electronic health records through monetary incentives to adopt and use certified technology.

Question 25

Medicaid

Answer 25

Title XIX of the Social Security Act of 1935; Medicaid provides financial assistance for healthcare coverage to poor and indigent populations.

Question 26

Medicare

Answer 26

Title XVIII of the Social Security Act of 1935; Medicare provides financial assistance for healthcare coverage to persons 65 years of age and over, to persons who are disabled, and to those with end-stage renal disease

Question 27

Medicare Prescription Drug Improvement and Modernization Act of 2003(MMA)

Answer 27

this act provides Medicare beneficiaries with financial assistance in paying for prescription medications

Question 28

mHealth

Answer 28

The sending and receiving of health information using a mobile phone, mobile device, or other wireless device

Question 29

Office of the National Coordinator for health information technology (ONC)

Answer 29

Located within the office of the secretary of Health and Human services, the ONC is the federal agency promoting a national health information technology infrastructure and overseeing its development.

Question 30

Omnibus Budget Reconciliation Act of 1986

Answer 30

The act that focused on substandard care and resulted in the requirement that PROs report substandard care to licensing agencies

Question 31

Patient-centered medical home (PCMH)

Answer 31

A healthcare model that involves the patient and family in the care of the patient; care is rendered in a team approach.

Question 32

patient-centric

Answer 32

Communications, information sharing, and decision making that includes the patient and is managed by both the patient and the provider

Question 33

patients rights

Answer 33

patients have the right to know who their healthcare team consists of, the right to privacy and confidentiality, the right to be informed about their diagnosis and treatment, the right to refuse treatment , the right to actively participate in their care plan, and the right to be cared for in a safe environment, free from abuse. Patients also have the right to read or have a copy (paper or electronic)of their health record, the rught to know who has accessed their health record, and the right to request an amendment to their health record

Question 34

physician quality reporting initiative (PQRI)

Answer 34

a voluntary pay for performance incentive program

Question 35

Population health management (PHM)

Answer 35

Clinical and financial activities undertaken to improve health outcomes and to lower costs for a defined group of individuals

Question 36

primary care physician (PCP)

Answer 36

a family practitioner, an internist, or a pediatrician who manages a patients basic healthcare needs and coordinates care with specialist la under a managed care insurance plan

Question 37

Prospective payment system (PPS)

Answer 37

a fixed reimbursement system based on the diagnosis related group (DRG) assigned to each inpatient stay; used by Medicare and Medicaid reimbursement and some third party payers

Question 38

Quality Improvement Organizations (QIO)

Answer 38

entities with which CMS contracts to review medical care , based on health record documentation, and to assist Medicare and Medicaid beneficiaries with complaints about quality of care issues and to implement improvements in the quality of care available throughout healthcare facilities try

Question 39

Tax Equity and Fiscal Responsibility Act of 1982(TEFRA)

Answer 39

Legislation that resulted in a shift from fee for service reimbursement to a prospective payment system

Question 40

The Joint Commision (TJC)

Answer 40

Formerly known as The Joint Commision on Accreditation of Hospitals, a voluntary accrediting agency holding deemed status by Medicare