Match the health care definition with the term
(Points : 13)
Potential Matches:
1 : Cost sharing
2 : Managed Care Organizations (MCO)
3 : Fee-for-Service (FFS)
4 : Diagnosis Related Group (DRG)
5 : Cultural Competency
6 : Capitation
7 : Prospective Payment System (PPS)
8 : Pay-for-performance
9 : Centers for Disease Control (CDC)
10 : Public Health
11 : Explanation of Benefits (EOB)
12 : Nostrum
13 : Gatekeeping
Answer
1 : Managed cares way of classifying patients by diagnosis, average length of hospital stay, and therapy received
2 : Summarizes what the insurance company paid the provider, how much the patient owes, and provides an up-to-date status of the patients annual deductible and out of pocket expenses
3 : Employees become part of their employers group insurance plan and the employer subsidizes the monthly premiums
4 : Emphasized environmental sanitation to stop the spread of epidemic diseases
5 : Each individual service or treatment is paid and billed separately
6 : A derogatory term for a medicine, especially an ineffective one, prepared by an unqualified person
7 : Involves bundled payments when physicians are paid for a series of treatments that are not billable individually
8 : Preventing unnecessary specialized care
9 : Global mission of health protection, prevention, and preparedness
10 : Practice of recognizing that different groups have unique health experiences and needs
11 : Enter into contracts with hospitals and healthcare professionals to provide healthcare to the beneficiaries in exchange for a negotiated rate per patient
12 : Amount of payment is determined prospectively, before the service is rendered
13 : Reimbursement models aimed at improving the quality, efficiency, and overall value of health care
Match the real word example with the term
(Points : 13)
Potential Matches:
1 : Nostrum
2 : Fee-for-Service
3 : Public Health
4 : Capitation
5 : Diagnosis Related Group (DRG)
6 : Gatekeeping
7 : Prospective Payment System (PPS)
8 : Pay-for-Performance
9 : Cost Sharing
10 : Explanation of Benefits (EOB)
11 : Managed Care Organization (MCO)
12 : Cultural Competency
13 : Centers for Disease Control (CDC)
Answer
1 : Hospitals, skilled nursing facilities and home health agencies are reimbursed on an episode of care basis
2 : Dr. Thomas exams a patient named Jan. Jans health insurance provider is Blue Cross Blue Shield. Services provided included a Chest X-ray, yearly physical, and removal of a mole. Dr. Thomas receives reimbursement for each service rendered
3 : Dr. Thomas exams a patient named Jen. Jens health insurance provider is HealthPlus of Michigan. Services provided included a yearly physical, removing a mole and ordering of labs and chest x-ray. Dr. Thomas receives reimbursement based on a contracted discounted rate
4] : Jan receives a report from the health plan listing the blood work, chest x-ray and physical she received at her primary care physicians office
5 : Mr. Jenkins owns a hardware in 1880s and starts to treat patients
6 : Dr. Thomas receives the same amount per patient per month whether the patient is receiving services or not
7] : Jan goes to the primary care physician in order to receive a referral to a specialist
8 : Jan is in severe pain evidenced by Nursing assessment of raised blood pressure, facial grimacing, and holding abdomen. However, she does not complain of pain
9 : Dr. Thomas reports to this entity that she has diagnosed a patient with Tuberculosis
10 : Jan is employed by ACME Tile, receives health insurance as a benefit and contributes $100/month to the premium
11 : Promotes a Youth advertising campaign to promote healthy eating and exercise
1 : Patient presents to the ER with COPD and is admitted to the hospital. The hospital is reimbursed based on the COPD Diagnosis
13: Dr. Thomas educates and advises patients on quitting smoking, exercise, and health eating. Dr. Thomas receives reimbursement for meeting quality measures
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