Unit 1 Chapter 19

Question 1

community facilities that receive tax exemptions in return for providing a community benefit

Answer 1

voluntary nonprofit institution

Question 2

for profit agency/ facility usually owned by a corporation that must pay local, state and federal taxes

Answer 2

proprietary institution

Question 3

measures designed to lower healthcare cost

Answer 3

healthcare cost containment

Question 4

public health facilities that receive most funding from local state and federal sources
ex: state mental hospital

Answer 4

government institutions

Question 5

primarily employment based health insurance system

Answer 5

private insurance

Question 6

pay for healthcare with own money

Answer 6

direct payment

Question 7

health care plan funded by a government agency

Answer 7

government plans

Question 8

heath care coverage for geriatrics

Answer 8

medicare

Question 9

health insurance for low income and disabled

Answer 9

medicaid

Question 10

provides medical care for active/retired military personnel and their dependents

Answer 10

TRICARE

Question 11

funds for uninsured children

Answer 11

CHIRPA

Question 12

vaccines
brushing teeth
actions taken to prevent diseases

Answer 12

preventive care

Question 13

GP, instead of specializing, helps patients maintain overall health by focusing on preventive care

Answer 13

primary physician

Question 14

contracted with insurance company to provide services to members

Answer 14

in network

Question 15

not contracted with health insurance plan

Answer 15

out of networ

Question 16

primary care physician gives this to see a specialist

Answer 16

referral

Question 17

goes to school more, charges more money, specialized in an area

Answer 17

specialist

Question 18

patient and practitioner use paperwork and telephone to contact insurance company to approve something

Answer 18

pre authorization

Question 19

process in which an insurer reviews decisions made my physician s and other providers about cost and amount of care provided

Answer 19

utilization review

Question 20

primary physician who delivers primary care but also makes referrals to specialty care and coordinates the health care services of patient

Answer 20

gatekeeper

Question 21

insurance company determines if proposed treatment is deemed medically necessary/ if theyll pay

Answer 21

pre authorization

Question 22

monthly amount paid to insurance company for coverage

Answer 22

premium

Question 23

amount someone pays before insurance company provides benefits/contributes

Answer 23

deductable

Question 24

describes plans that require the insured to share a portion of the costs for health care services

Answer 24

co insurance

Question 25

flat fee patient pays every time they receive a service at doc

Answer 25

co pay

Question 26

used my medicare and medicaid to determine payment for health services

Answer 26

DRGS

Question 27

DRG

Answer 27

diagnostic related group

Question 28

assigned to DRG based on

Answer 28

diagnosis

demographical info

Question 29

paid in standard fees instead of actual costs

offers incentive to hospital to operate more efficiently

Answer 29

DRGS

Question 30

utilizing resources efficiently
time management
EX: taking vitals while waiting for doc or using electronic documentation

Answer 30

resource utilization

Question 31

premium
pick in network primary physician
copay
no deductible

Answer 31

HMO

Question 32

premium
pick PP in network
copay
no deductible
UNLESS
out of network 
pay deductible then submit for reimbursement

Answer 32

PPO

Question 33

premium
go to any doc/ hospital
pay bill and submit to insurance

Answer 33

traditional/ indemnity

Question 34

takes % out of everyones paycheck to ensure health care coverage

Answer 34

universal healthcare

Question 35

states most americans have health insurance

children stay on parents plan till 26

Answer 35

obamacare

Question 36

obamacare AKA

Answer 36

affordable care act

Question 37

offered through employer and usually paired with tradit. policy, funds in acc can be withdrawn if approved for medical care, but must be spent

Answer 37

FSA (flexible spending account)

Question 38

establishes predetermined rates for services with healthcare providers such as Md and hospital
in the position of managing patients use of health care

Answer 38

managed care

Question 39

combines HMO AND PPO

physician coordinated

Answer 39

POS