medical Thursday 12 Flashcards
Medicare
Is insurance that’s for elderly people (65+)
Tricare
Is insurance that benefits retired military soldiers, as well as their families
Medicaid
Is insurance that provides for people that have low-income
SCHIP
This is a children’s health insurance program
Managed care
One response to rapid escalation in health care costs
Regulatory compliance
The practice of adhering to federal healthcare laws a regulation which prohibit and prevent fraud, abuse, waste in health care
Quality assurance
the maintenance of a desired level of quality in a service or product, especially by means of attention to every stage of the process of delivery or production.
Resource utilization
All healthcare workers need to ask themselves how they can best use health care recourses
Which of the terms in # 3 describes managing time, staff, equipment, technology, and facilities in providing health care?
Resource utilization
Which type of health insurance coverage is obtained through an employer or purchased as an individual policy?
Private insurance
Which type of healthcare facility receives federal, state, and local tax exemptions in exchange for providing a community benefit, such as care for Medicaid and other low-income patients?
non-profit
Measures designed to lower health care costs are known as ____
Cost containment
Health Maintenance Organization:
Provides coverage only if the care is delivered by a member of its hospital, physician, or pharmacy panel
Point of Service Plan
This is a physician coordinated plan that combines characteristics both of HMO and PPO plans.
Preferred Provider Organization
This plan allows patients to receive care from a nonplan provider, but requires them to pay higher out-of-pocket prices if they do so
Restricted Network plan
A limited network of health providers
Of the plans listed in # 8, which type has a contracted network of providers but also allows members to receive care from non-participating providers? Which one involves the coordination of care by a primary care physician and is a hybrid of HMO and PPO structures? Which one provides coverage only if services are provided by members of its hospital, physician, or pharmacy panel?
Define Prospective Payment System
Payment Mechanism sets predetermined rates of payment to providers for the treatment of Specific illnesses and conditions
Outpatient facility
medical facilities that perform procedures that do not require an overnight stay in a hospital or care facility.
Government funded facility
is a public healthcare facility that receives most of its funding from local, state, or federal sources.
Nonprofit facility
Proprietary facility
for-profit health-care facility usually owned by cooperation.
To which type of facility listed in #12 would a VA hospital belong to?
What is the purpose of a diagnostic related group?
to relate a hospital’s case mix to the resource demands and associated costs experienced by the hospital.
Which type of health care facility is privately owned and is operated as a for-profit organization?
What does it mean when a provider is “out-of-network”?
When you are not in the plan.
Which government health plan provides coverage for citizens age 65 and older?
Medicare
What is a copay?
pay a flat fee
What is a flexible spending account?
It is a most common medical saving account
What is a health savings account?
is commonly paired with a high-deductible health insurance plan. A plan that offers low monthly premiums but requires an insured person to pay a high deductible.
What is coinsurance?
Term to describe plans that require the insured to share a portion of costs in health care services
What is an insurance premium?
Amount paid for a health care insurance policy
What is a deductible?
is the money a person pays before the insurance policy providers benefits
What is the role of a “gatekeeper” in a health insurance company?
A physician who not only delivers primary care services but also makes referrals for specialty care.
