Health Care Systems And Settings Flashcards
Health care licensure
Licensure is state-regulated and issued upon graduation from a medical institution.
Accountable care organizations (ACOs)
A group of medical professionals come together to voluntarily provide high-quality care to their Medicare patients
Capitation
In this payment model, patients are assigned a per-member, per-month payment based on sex, age, race,etc
Global budget
This is a fixed dollar amount paid annually for all care
Health maintenance organization (HMOs)
This plan contracts with a medical center to provide preventative and acute care for the insured person
Patient-centered medical home
A primary care provider coordinates treatment to make sure patients receive the required care when and where they need it, and in a way they can understand
Hematologist
Deal with blood and blood producing organs
Ophthalmologist
Specialize in eye conditions
Otolaryngologist
Specializes in ear, nose,and throat
Pathologist
Specializes in body tissues, blood, urine, and other bodily fluids to diagnose
Advance beneficiary notice
A form provided to the patient when the provider believes Medicare will probably not pay for services recevied
Allowed amount
The maximum amount a third party payer will pay for a service
Copayment
An amount that is paid at the time of the medical service
Coinsurance
A policy provision frequently found in medical insurance whereby the holder had company share the cost in a ratio
Participating provider
Providers who agree to write off difference between the amount charged by the provider and the approved fee established by the insurer
Medicare
Generally covers patients above 65 with hospitalization and office visits
Tricare
Authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government
CHAMPVA
Covers surviving spouses and children of veterans who died because of their service
Medicaid
Provides health insurance to the medically indigent population through a cost-sharing program between federal and state govt.
Managed care
An umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care
Worker’s compensation
Protects wage earners against the loss of wages and cost of medical care resultIng from an occupational accident
Clearinghouse submissions
Clearinghouse submissions for claims allows a provider to submit all insurance claims using distinctive software
