Jeopardy Prep for Final Exam

Question 1

Under this payment system, the insurer limits risk by paying one fee to the provider for a set of patient services

Answer 1

What is the Bundled Payment System?

Question 2

Under this payment system, providers are paid a set sum on a regular basis

Answer 2

What is Capitation?

Question 3

Which Managed Care Provider Structure contracts with multidisciplinary providers groups and practices? (hint: this model is commonly seem in large, multispecialty practices)

Answer 3

What is: The Group Model

Question 4

Managed Care has 3 principles. This principle includes data collection and peer review (hint: Table 7-1).

Answer 4

What is: Enhanced Quality Improvement

Question 5

This Managed Care Product allows individuals greater control over their health utilization and spending

Answer 5

What is: Consumer-Directed Health Plans

Question 6

The following are criteria for eligibility for what service?

Permanently disabled any age
Diagnosis of End Stage Renal Disease or ALS at any stage
65 years or older

Answer 6

What is: Medicare Part A

Question 7

This area of Medicare pays for most professional services, outpatient, and DME

Answer 7

What is: Med B

Question 8

This is an annual income amount based on family size. This is used to assess qualifications for Medicaid.

Answer 8

What is: The Federal Poverty Level (FPL)

Question 9

In 2010, this piece of legislation expanded Medicaid Coverage.

Answer 9

What is the Patient Protection and Affordable Care Act (PPACA), AKA ACA?

Question 10

The Utilization Review for fraud and abuse has 3 level. The following describes what level: __ Level reviews the utilization pattern against an edit”

Answer 10

What is Level I

Question 11

These types of hospitals are managed by community boards or religious organizations. They often had federal and state tax exemptions

Answer 11

What is a Not-for-Profit Hospital?

Question 12

Primary Care, Secondary Care, Tertiary Care, and Quaternary Care

Answer 12

What are the 4 levels of care in acute care?

Question 13

There are 3 level of Acute Care. A therapist treating at this level usually treats patients with common, chronic-type disorders, which often need to be treated over a long period of time.

Answer 13

What is Secondary Care?

Question 14

In the post-acute health care system, there are two types of formal care. This type of formal care provides a place for the person to live along with other services.

Answer 14

What is: Residential formal care

Question 15

In this type of care, a patient is receiving a regulated program of care, which provides a range of medical, therapeutic, and nonmedical services; delivered by a variety of health care professionals in the patient’s home (hint: is it informal/formal? What type and where?)

Answer 15

What is: Non-residential Formal Care: Home Health Care

Question 16

An IEP must address several items and has an emphasis on student-driven and family-centered practices.

Answer 16

What is the Required Components of an IEP?

Question 17

Autism, speech and language impairments, and TBIs are examples of disability categories under this piece of legislation.

Answer 17

What is IDEA?

Question 18

This community based mental health setting is described below: You work with community based patients, ages18-50, with schizoaffective disorder. You enroll one of your patient’s in a program that provides structure and support during the day.

Answer 18

What is Adult Day Service Programs?

Question 19

4 Traditional Mental Health Practice Settings

Answer 19

What are Acute and Subacute Hospitalization, Long-Term Hospitalization, Partial Hospitalization, and Crisis Stabilization?

Question 20

This mental health practice settings is the best placement for the case study described: Jim has a diagnosis from the DSM-V and has been managing well, but recently things have begun taking a turn for the worse. He feels as though he is in an early stage of crisis. To prevent an unneeded hospitalization, Jim seeks out help from this setting, which provides immediate, short term, residential care 24/7.

Answer 20

What is Crisis Stabilization?

Question 21

“A health care system that maximizes the quality of care and oncome given the committed resources as well as ensuring that additional investments yield a net value” (p. 235)

Answer 21

What is Efficiency?

Question 22

Complementary health approaches and integrative health (CHAIH)

Answer 22

What is the approach used to avert symptoms or manage clinical conditions to increase quality of life? It may include preparatory methods and tasks.

Question 23

Cultural Awareness, Cultural Preparedness, Cultural Picture of the Person, Cultural Responsiveness, Cultural Readiness, and Cultural Competence

Answer 23

What are the 6 Stages of Cultural Competency?

Question 24

When comparing health care systems, this dimension consists of four categories:
1) effective care
2) self care
3) coordinated care and
4) patient-centered care.
The U.S. has positive findings relating to providing preventive and patient-centered care, but low rankings for safe and coordinated care.

Answer 24

What is Quality?

Question 25

The following best describes this countries health care system:
Universal coverage system, which covers all residents and is publicly financed through Statutory Health Insurance (SHI). This system employs three forms of cost sharing through co-insurance, co-payments, and extra billing. This system covers limited services, including ambulatory care, hospital care, and prescription drugs.

Answer 25

What is France’s Health Care System?

Question 26

The following illustrates this form of Post-Acute care: John has Cancer and has been given a prognosis of 3 months. He has begun to receive services for his terminal illness including pain management and emotional counseling while his family is also supported.

Answer 26

Non-residential formal care: Hospice