Public Health 2.0, Renal, Heme Flashcards
Medical Insurance Plan Restricted to limited panel, except emergencies
Exclusive Provider Organization
Medical Insurance Plan Restricted to limited panel, except emergencies Deny for any service that does not meet established evidence-based guidelines
Health Maintenance Organization
Medical Insurance Plan Patient can see providers outside network I need a referral Higher copays and deductible for out of network services
Point of Service
Medical Insurance Plan Patient can see providers outside network I do not need a referral Higher copays and deductibles for all services
Preferred Provider Organization
Medical Insurance Plan Providers voluntarily enroll Medicare
Accountable Care Organization
Disease prevention, what type is this? Prevent disease before it occurs
Primary Disease Prevention
Disease prevention, what type is this? Screen early for and manage existing but asymptomatic disease (Pap Smear)
Secondary Disease Prevention
Disease prevention, what type is this? Treatment to reduce complications from disease that is ongoing or has long term effects
Tertiary Disease Prevention
Disease prevention, what type is this? Identifying patients at risk of unnecessary treatment, protecting from the harm of new interventions?
Quaternary Disease Prevention
Healthcare Payment Models Healthcare organization receives a set amount per service, regardless of ultimate cost, to be divided among all providers and facilities involved
Bundled Payment
Healthcare Payment Models Physicians receive a set amount per patient assigned to them per period of time, regardless of how much the patient uses the healthcare system, used by HMO
Capitation
Healthcare Payment Models Patient Pays for each individual service at a discounted rate predetermined by providers and payers
Discounted Fee for Service
Healthcare Payment Models Patient pays for each individual service
Fee-for-Service
Healthcare Payment Models Patient pays for all expenses associated with a single incident of care with a single payment. Most commonly used during elective surgeries, as it covers the cost of surgery as well as the necessary pre and postoperative visits
Global Payment
Who uses…. Medicare? Medicaid?
Medicare is Elderly Medicaid is Destitute
Medicare parts, which one is? Hospital Insurance, home hospice care
Part A
Medicare parts, which one is? Basic medical Bills, doctor’s fee, and diagnostic testing
Part B
Medicare parts, which one is? Combo of hospital insurance, home hospice care, and basic medical bills
Part C
Medicare parts, which one is? Prescription Drugs
Part D
