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16 Cards in this Set

  • Front
  • Back
IN the U.S. , the 1965 ____ amendments to the Social Security Act provided a nation and state health insurance program for adults.
Part ___ of medicare is available to people with disabilities and people 65 years and over. It provides insurance toward hospitalization, home care, and hospice care.
Part ___ is voluntary and provides partial coverage of physician services to people eligible for part A. Clients pay a monthly premium for this coverage.
___ is the 20% share of a government approved charge that is paid by the client; the other 80% is paid by the plan.
____ was also established in 1965 under title 19 of the Social Security Act. It is a federal public assistance program paid out of general taxes to people who require financial assistance, such as people with low incomes. It's paid by federal and state governments.
In 1978, ____ ____ clinics Act provided for the development of health care in medically undeserved rural areas. This act opened the door for nurse practitioners to provide primary care.
Rural Health
Person with disabilities or those who are blind may be eligible for special payments called ____ ______ ______ benefits. These benefits are also available to people not eligible for Social Security, and payments are not restricted to health care costs. Clients often use this money to purchase medicines or to cover costs of extended health care.
Supplemental Security Income
To curtail health care costs in the United States, Congress in 1983 passed legislation putting the prospective payment system into effect. This legislation limits the amount paid to hospitals that are reimbursed by Medicare. Reimbursement is made according to a classification system known as ______ ____ _____. The system has catagories that establish pretreatment diagnosis billing categories.
diagnosis related groups
Private health insurance is known as _____ reimbursement because the insurance company pays either the entire bill, or more often, 80% of the costs of health care servides. With private insurance halth plans, the insurance company reimburses the health care provider a fee for each service provided.
third party
A ____ ____ organization is a group health care agency that provides basic and supplemental health maintenance and treatment services to voluntary enrollees. A fee is set without regard to the amount or kind of services provided. They choose a physician and if they cannot treat it they will make referrels.
health maintenance organization HMO
The ____ ____ organization has emerged as another alternative in the health care delivery system It consist of a group of physicians and perhaps a health care agency taht provide an insurance company or employer with health services at a discounted rate. One advantage of ths is that it provides clients with a choice of health care providers and services. A disadvantage is that they tend to be slightly more expensive than HMO plans and if individuals wish to join they might have to pay more for the additional choices
preferred provider organization PPO
Preferred provider ____ are similar to PPOs. the main difference is that they can be contracted with individual health care providers whereas ppos involve an organization of health care providers. plan can be limited or unlimited.
Prefered provider arrangements.
____ practice associations are somewhat like HMOs and PPOs. they provide care in offices, just as the providers belonging to a PPO do. The difference is that clients pay a fixed prospective payment and then they pay the provider.
Independent practice association
____ delivery system incorporates acute care services, home health care, extended and skilled care facilities, and outpatient services. Most provide care throughout the life span. It enhances continuity of care and communication between professionals and various agencies providing managed care.
integrated delivery system
The previous ____ fee system for physician payments was replaced with a new one determined by an innovative Resource-based relative value scale(rbrvs). The objective was to bring the payments for different types of medical services more in line with the physician skills and required and the actual time spent on the specific procedures. It sought to correct the disparity between Medicare's high payments for this type of procedure and relatively low payments for more hands on primary care. Payments to primary care and internal medicine physicians were increased, whereas fees for many specialists were reduced.
cost ___ was the "heath issue" from the mid 1970's through the 1980's because health care costs increased much more rapidly than prices of most other goods and services.