medical Thursday 12

Question 1

Medicare

Answer 1

Is insurance that’s for elderly people (65+)

Question 2

Tricare

Answer 2

Is insurance that benefits retired military soldiers, as well as their families

Question 3

Medicaid

Answer 3

Is insurance that provides for people that have low-income

Question 4

SCHIP

Answer 4

This is a children’s health insurance program

Question 5

Managed care

Answer 5

One response to rapid escalation in health care costs

Question 6

Regulatory compliance

Answer 6

The practice of adhering to federal healthcare laws a regulation which prohibit and prevent fraud, abuse, waste in health care

Question 7

Quality assurance

Answer 7

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.

Question 8

Resource utilization

Answer 8

All healthcare workers need to ask themselves how they can best use health care recourses

Question 9

Which of the terms in # 3 describes managing time, staff, equipment, technology, and facilities in providing health care?

Answer 9

Resource utilization

Question 10

Which type of health insurance coverage is obtained through an employer or purchased as an individual policy?

Answer 10

Private insurance

Question 11

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?

Answer 11

non-profit

Question 12

Measures designed to lower health care costs are known as ____

Answer 12

Cost containment

Question 13

Health Maintenance Organization:

Answer 13

Provides coverage only if the care is delivered by a member of its hospital, physician, or pharmacy panel

Question 14

Point of Service Plan

Answer 14

This is a physician coordinated plan that combines characteristics both of HMO and PPO plans.

Question 15

Preferred Provider Organization

Answer 15

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

Question 16

Restricted Network plan

Answer 16

A limited network of health providers

Question 17

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?

Question 18

Define Prospective Payment System

Answer 18

Payment Mechanism sets predetermined rates of payment to providers for the treatment of Specific illnesses and conditions

Question 19

Outpatient facility

Answer 19

medical facilities that perform procedures that do not require an overnight stay in a hospital or care facility.

Question 20

Government funded facility

Answer 20

is a public healthcare facility that receives most of its funding from local, state, or federal sources.

Question 21

Nonprofit facility

Question 22

Proprietary facility

Answer 22

for-profit health-care facility usually owned by cooperation.

Question 23

To which type of facility listed in #12 would a VA hospital belong to?

Question 24

What is the purpose of a diagnostic related group?

Answer 24

to relate a hospital’s case mix to the resource demands and associated costs experienced by the hospital.

Question 25

Which type of health care facility is privately owned and is operated as a for-profit organization?

Question 26

What does it mean when a provider is “out-of-network”?

Answer 26

When you are not in the plan.

Question 27

Which government health plan provides coverage for citizens age 65 and older?

Answer 27

Medicare

Question 28

What is a copay?

Answer 28

pay a flat fee

Question 29

What is a flexible spending account?

Answer 29

It is a most common medical saving account

Question 30

What is a health savings account?

Answer 30

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.

Question 31

What is coinsurance?

Answer 31

Term to describe plans that require the insured to share a portion of costs in health care services

Question 32

What is an insurance premium?

Answer 32

Amount paid for a health care insurance policy

Question 33

What is a deductible?

Answer 33

is the money a person pays before the insurance policy providers benefits

Question 34

What is the role of a “gatekeeper” in a health insurance company?

Answer 34

A physician who not only delivers primary care services but also makes referrals for specialty care.