Unit 4: Healthcare Systems Flashcards
Deductibles
A specified amount of money that the insured must pay before an insurance company will pay a claim.
What does HIPPA security rule do?
Establishes standards for the protection health information that is held or transferred in electronic form.
Which part of Medicare helps pay for the services of physicians, outpatient hospital services, and medical equipment and supplies?
Part B
WHO (World Health Organization) is sponsored by who?
United Nations
Patients are able to perform many of their own activities of daily living (ADL) may utilize which of the following facilities?
Assisted living
Profit
Owners obtain money from the profits of the agency; taxation
If the coinsurance is 80/20%, how much does 1). The company pay? 2). The patient pay?
1). 80% 2). 20%
Which of the following provides care for terminally ill people who usually have 6 month or less to live?
Hospice
Which part of Medicare provides for hospital care, long-term care facilities, home health services, and hospice care?
Part A
If someone’s premium is $300 per month, what is their annual premium payment?
$3,600
DRG’s
Designed by Congress to lower healthcare cost. A flat rate is reimbursed based on the illness or procedure no matter what the facility charges.
Hospice
Services are provided to the terminally ill; those who have 6 months or less to live
What must you have with an HMO?
A primary care physician
What government agency regulates food and drug products that are sold to the public?
Food and Drug Administration (FDA)
Copayment
A payment made by a beneficiary (especially for health services) that is made by an insurer.
Medicare
Federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant called ESRD)
Non-profit agencies
Most deal with specific diseases or groups of diseases.
Food & Drug Administration
A federal agency responsible for regulating the food and drug products sold to the public.
Residential care
Nursing home
What are the 4 types of hospitals?
General hospitals, specialty hospitals, government hospitals, university/college medical centers
Worker’s Compensation
A form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employees right to sue their employer for the tort of negligence.
Managed care
Monitors healthcare services to ensure the purpose was appropriate; a second chance is often required.
Medicaid
Healthcare program that assists low-income families or individuals in paying for long-term medical and custodial care costs. Medicaid is a joint program, funded primarily by the federal government and run at the state level, where coverages may vary.
Tricare
A healthcare insurance system for military dependents and members of the military services that covers care not available through the usual U.S. military medical service or public health service facilities. CHAMPUS was the first federal third-party reimbursement system to pay for care rendered by nurse-midwives and nurse practitioners.
World Health Organization
An international governmental agency sponsored by the United Nations. It compiles statistics and investigated serious health problems throughout the world.
When you go to the doctor, you may have to pay and amount of money regardless of the cost of the visit. What is this called?
Copay
What type of insurance covers accidents, injuries, or diseases that occur in the workplace?
Worker’s compensation
Assisted Living Facilities
Independent living; provides basic services (meals/housekeeping); basic medical care
Coinsurance
A type of insurance in which the insured pays a share of the payment made against a claim.
Local Health Departments
Provides immunization
Preferred Provider Organization
Insurance that contracts with doctors to provide medical services at reduced rates, but employees are restricted to using doctors from a list.
Which of the following may also be referred to as a nursing home?
Long-term care facility
U.S. Department of Health and Human Services (DHHS)
National agencies that advises on health and welfare plans; policies and federal government programs; agencies under DHHS include CDC, FDA, AHRQ
In health insurance terminology, what is coinsurance?
NIH is a division of which organization?
USDHHS
