Health Care Systems And Settings

Question 1

Health care licensure

Answer 1

Licensure is state-regulated and issued upon graduation from a medical institution.

Question 2

Accountable care organizations (ACOs)

Answer 2

A group of medical professionals come together to voluntarily provide high-quality care to their Medicare patients

Question 3

Capitation

Answer 3

In this payment model, patients are assigned a per-member, per-month payment based on sex, age, race,etc

Question 4

Global budget

Answer 4

This is a fixed dollar amount paid annually for all care

Question 5

Health maintenance organization (HMOs)

Answer 5

This plan contracts with a medical center to provide preventative and acute care for the insured person

Question 6

Patient-centered medical home

Answer 6

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

Question 7

Hematologist

Answer 7

Deal with blood and blood producing organs

Question 8

Ophthalmologist

Answer 8

Specialize in eye conditions

Question 9

Otolaryngologist

Answer 9

Specializes in ear, nose,and throat

Question 10

Pathologist

Answer 10

Specializes in body tissues, blood, urine, and other bodily fluids to diagnose

Question 11

Advance beneficiary notice

Answer 11

A form provided to the patient when the provider believes Medicare will probably not pay for services recevied

Question 12

Allowed amount

Answer 12

The maximum amount a third party payer will pay for a service

Question 13

Copayment

Answer 13

An amount that is paid at the time of the medical service

Question 14

Coinsurance

Answer 14

A policy provision frequently found in medical insurance whereby the holder had company share the cost in a ratio

Question 15

Participating provider

Answer 15

Providers who agree to write off difference between the amount charged by the provider and the approved fee established by the insurer

Question 16

Medicare

Answer 16

Generally covers patients above 65 with hospitalization and office visits

Question 17

Tricare

Answer 17

Authorizes dependents of military personnel to receive treatment from civilian providers at the expense of the federal government

Question 18

CHAMPVA

Answer 18

Covers surviving spouses and children of veterans who died because of their service

Question 19

Medicaid

Answer 19

Provides health insurance to the medically indigent population through a cost-sharing program between federal and state govt.

Question 20

Managed care

Answer 20

An umbrella term for plans that provide health care in return for preset scheduled payments and coordinated care

Question 21

Worker’s compensation

Answer 21

Protects wage earners against the loss of wages and cost of medical care resultIng from an occupational accident

Question 22

Clearinghouse submissions

Answer 22

Clearinghouse submissions for claims allows a provider to submit all insurance claims using distinctive software