Healthcare Delivery Models Flashcards

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1
Q

What are government plans?

A

Medicare: over 65
Part A Hospitalization
Part B Office Visits
Part D Medications
Medicaid: cant pay, low income

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2
Q

TriCare

A

Active duty service / family

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3
Q

CHAMPVA

A

Veteran’s Affairs

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4
Q

Private Plans thru Employer

A

Group/ individual
Oldest -BCBS

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5
Q

Worders Comp

A

Paid by employer for incidents at work

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6
Q

Insurance Terminology

A
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7
Q

Allowed amount

A

Max amount third party will pay

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8
Q

CoPay

A

set amount patient pays at time of service

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9
Q

CoInsurance

A

Member & insurance company split cost, usually 80/20%

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10
Q

Deductible

A

Amount of money paid out of pocket, before insurance company begins paying

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11
Q

Billing FORM

A

CMS 1500

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12
Q

Direct Billing

A

Provider submit direct to insurance

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13
Q

ClearingHouse

A

Submit claims using software, house audits, sorts, scrubs for mistakes

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14
Q

Medicare / Medicaid

A

Invoice cannot exceed 12 months from service

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15
Q

Key Terms

A
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16
Q

Ambulatory care

A

patient can walk

17
Q

Managed Care

A

Plans provide care in return for scheduled payments

18
Q

Osteopathic

A

medicine based on musculoskeletal system, manipulation. Affects other body parts. Conventional, pharmacology, therapeutic procedures

19
Q

Professionalism

A

Skills, behavior & judgement that represent best qualities

20
Q

Work Ethic

A

Values based on moral virtues and diligence