Insurance >:(

Question 1

what is PPS?

Answer 1

prospective payment system
- limit and standardize the medicare/medicaid payments made to hospital

Question 2

what is DRGS

Answer 2

• diagnosis-related groups
• designed by AHA (hospitals are reimbursed a set amount for each pt procedure using established siease categories)

Question 3

what is APC

Answer 3

determining payment to healthcare facilities for medicare and aid only

Question 4

what is FFS

Answer 4

fee for service
- traditional
- reimbursement for healthcare services by third party

Question 5

What is used to code diseases

Answer 5

ICD10 (international classifciation ofdiseases) procedural coding system
- only in US
- in patient
- clinical modificaitojn of ICD 10

Question 6

what is CPT

Answer 6

current procuedural terminology

Question 7

what is ACO

Answer 7

accountable care organization
- network that voluntarily offer ot coordinate care for medicare pt

Question 8

what is managed care ?

Answer 8

• payment system that attempts to control costs and access to healthcare and strives to meet high quality standards
• limit proivders, US PCDP, case manager, all healthcare services review
• contract with helathcare facilities

Question 9

wjat is HMO

Answer 9

prepaid negotiated discounded basis of admission

Question 10

PPOs

Answer 10

independent group of physicians or hospitals that offer serivces to employers at discounted rates in exchange for pt

Question 11

IDNs/ IDSs

Answer 11

integraded delivery networks
- several assocatiod medical facilities that coordinate healthcare from prebirth to death

Question 12

what are patient care services

Answer 12

• NURSING CARE direct pt care
• EMERgency care
• ICU
• surgery

Question 13

what are support services

Answer 13

• central supply
• deitary services
• environmental services
• health IT

Question 14

what are professional services

Answer 14

• Cardiodiagnostics
• pathology and clinical alb
  = ENT or EEG
• OT
• pharm
• PT
  = RT
• idagnostic radiology services