Glossary Flashcards
A healthcare delivery process that helps achieve better outcomes by anticipating and linking clients with services they need.
Care Management
An illness or injury that prevents an insured person from continuously performing every duty pertaining to occupation or engaging in any other type of work.
Total Disability
Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options. Promotes quality, cost effective outcomes.
Case management
Conducted while the patient is in the hospital, care is reviewed for appropriateness.
First level review
A management entity owned by a hospital, physician organization, or third party. It contracts with payers and hospitals to provide certain healthcare management services such as negotiating fee schedules and handling administrative functions including um billing and collections.
Management Service Organization
Ratio of healthcare costs to revenue received. Calculated as total medical expense divided by total revenue.
Medical loss ratio (MLR)
An injury that may require medical care but does not result in loss of working time or income.
Non-disabling injury.
A prospective nursing assessment instrument completed by home health agencies when a patient is entered for services. What does scoring determine?
Outcome and assessment information set (oasis)
Home health resource group (HHRG)
What does physical disability usually not include?
Single sensory handicaps such as blindness or deafness.
The use of activities and programs to ensure quality of patient care. These activities are designed to monitor, prevent and correct quality deficiencies and noncompliance with standards of care and practice.
Quality assurance
Array of techniques and methods used for data collection and analysis of data gathered in the course of current healthcare practices in a defined setting to identify and resolve problems in the system and improve processes and outcomes of care.
Quality improvement
A fixed amount of money per member per month paid to are provider rather than for specific services.
Capitation
Telephone triage and online services to reduce avoidable visits to health providers.
Demand management.
Prospective payment system is used for what type of patients?
Medicaid and Medicare
