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35 Cards in this Set
- Front
- Back
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Medicare
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also know as Title XVll of the Social Security Act (SSA) of 1965, provides healthcare to Americans 65 and older. |
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HIPPA HIPPA - mandates regulations that govern: |
-give patients better access to insurance -limit fraud and abuse -reduce administrative costs -Security -Privacy -Electronic transaction standards for health information |
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Medical Care
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Identify (diagnose) the illness and provide care (treat) |
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Copayment
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Provision in insurance policy that policyholder or patient pays a specific dollar amount to the provider for each visit or medical service rendered
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Group Health Insurance Coverage
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Healthcare coverage available through employer/organization and the employer/organization pays part of all of the premium costs |
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Preventative Services
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Provide early detection of health problems and allows treatment options that are less expensive and dramatic |
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Disability Insurance
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Is just one of many different types of insurance coverage.
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Hospitalist and Residents
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Practice medicine only in a hospital setting. |
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2007 Census data estimates
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Approximately 85% of people in the U.S. were covered by health insurance |
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Health insurance is available to individuals who
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-Participate in prepaid health plans -Participate in group health plans |
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What introduced the first insurance policy?
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Franklin Health Assurance Company of Massachusetts |
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MCR |
Medicare Contracting Reform initiative was established to integrate the administration of Medical parts A & B
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Who provided Worker's Compensation for federal employees of the federal employees in unusually hazardous jobs?
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President Theodore Roosevelt signed legislation in 1908
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Federal Employees' Compensation Act replaced the 1908 worker's compensation legislation and civilian employees of the federal government with
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-Survivor Benefits -Compensation for lost wages |
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TPAs
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Third Party Administrators administer healthcare plans process claims they serve as a system of checks and balances for labor and management. |
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2007 census data showed 28% of people in the U.S.
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Are covered by government plans (Medicare, Medicaid and Tricare). |
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Insurance companies guarantee payment
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To the insured in the event of an unforeseen event in exchange for a monthly premium. |
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POR
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-Initial plan -Progress Notes -Data base Database collects several pieces of information, including : -Chief complaint -Review of systems (ROS) -Present condition and diagnosis -Physical exam |
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IPF PPS= |
Inpatient Psychiatric Facility Prospective Payment System was begun January 1, 2005. |
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Worker's Compensation
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is mandated by federal and state government and requires employers to cover medical expenses and lost wages for employees injured on the job. |
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OSHA |
Occupational Safety and Health Administrative Act of 1970 was designed to protect employees against injuries due to occupational hazards in the workplace.
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Tricare has three plans options: |
-Tricare Prime -Tricare Extra |
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OPPS |
Outpatient Prospective Payment Systems uses the Ambulatory Payment Classification (APCs) to calculate reimbursement for billing of hospital-based Medicare outpatient claims. |
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Who had the first Blue Shield plan? |
California |
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CLIA |
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Major Medical Insurance |
Provides coverage for catastrophic or prolonged illness and injuries |
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Deductible |
The amount the patient is financially responsible for before insurance pays |
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HMO
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Provide healthcare services to subscribers in a given geographical area for a fixed fee |
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NCCI |
National Correct Coding Initiative... promotes correct coding methodologies |
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What is Insurance?
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is essentially a contract that protects from loss |
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Total Practice Management software automates the following medical practice functions:
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-Scheduling patients -Generate claims and patient statements -Process payments form patient and third party payer -Produce administrative and clinical reports |
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Coinsurance
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The percentage of cost the patient shares with the health plan
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Based Period |
Weekly benefit amount divided into quarters |
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Title XIX of the SSA of 1965 deals with Patient record
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Patient visit documentation |
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Prepaid health plans |
Were the forerunners of today's managed care plans.
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