Prof quiz 3 hints, part 2 Flashcards

1
Q

Reimbursement definition

A

Determination of methods and amounts of reimbursement in advance of delivery

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2
Q

Disbursement defintion

A

Actual payment after services have been rendered

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3
Q

Charge definition

A

A price set by provider

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4
Q

Rate definition

A

A price set by a 3rd party payer

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5
Q

Fee schedule definition

A

An index of charges listing individual fees for each type of svc

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6
Q

Aspects of fee for svc

A

The oldest method
Charges are set by the provider
Each svc billed separately
Later insurers adopted UCR (usual, customary and reasonable) charge
Main drawback is provider-induced demand

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7
Q

Aspects of capitation

A

Per member per month (PMPM) fee to cover all needed svcs
Monthly fee = PMPM rate x number of enrollees
Minimizes provider induced demand and promotes prudence

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8
Q

Aspects of outpatient care as compared to ambulatory care

A

More comprehensive
Outpt svcs: any HC svcs that are not provided on the basis of an overnight stay in which room and board are incurred

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9
Q

Aspects of ambulatory care as compared to outpt care

A

Care rendered to the “walking” (ambulatory) pts who come to the physician office, clinics, or outpt surgery
Diagnostic and therapeutic
Mobile diagnostic units and home health
Take svcs to pts

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10
Q

Aspects of primary care in terms of outpt vs ambulatory

A

The foundation for ambulatory care
All primary care is outpt
Not all outpt care is primary care

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11
Q

Reasons for growth in outpt svcs

A

Changes in reimbursement
Fewer payment restrictions
Development of new tech
Utilization controls by managed care
Social factors

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12
Q

Trends in changes in reimbursement for outpt svcs

A

Constraining inpt svcs
Favoring outpt svcs

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13
Q

Where are there fewer payment restrictions in outpt svcs?

A

Surgery, dialysis, chemotherapy
Paid as fee for service

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14
Q

Developments in new tech for outpt- what do they result in?

A

Less invasive procedures
Quicker recuperation from surgery

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15
Q

How have utilization controls by managed care affected outpt growth?

A

Restriction on utilization, quicker d/c
-Prior auth
-Utilization review

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16
Q

How have social factors affected outpt growth?

A

Preference for obtaining svcs at home or in community-based settings, esp LTC

17
Q

What does home HC do?

A

Services brought into the home

18
Q

What is an alternative to home HC?

A

Institutionalization

19
Q

What does home health care include?

A

Nursing care
Medication monitoring
Bathing
Short-term rehab (PT, OT,ST)
Homemaker service (meal prep, shopping, transportation, medical equipment, chores)
Durable medical equipment (DME): wheelchairs, oxygen, beds, walkers, commodes

20
Q

What are the demographic characteristics of home HC pts?

A

Tend to be 65 or older, female, and white

21
Q

What are the two main types of ambulatory LTC svcs?

A

Case management
Adult day care

22
Q

Aspects of case management

A

Coordination and referral
To find the most appropriate care

23
Q

Aspects of adult day care

A

Complements informal care at home
Svcs during the nl work day

24
Q

What is the total cost for all hospital inpt stays?

A

$381.4 billion in 2013

25
Q

What is the cost per day in US hospitals in comparison to other developed countries?

A

3-9 x in other developed countries