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35 Cards in this Set
- Front
- Back
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Baylor Plan
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1st Insurance company to provide health insurance to its employers. Started Blue Cross (covered hospital visits)
Blue Shield (physician services) |
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WWII?
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Soldiers got free healthcare b/c of their enlistment
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Medicare?
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Started in 1965 Title XVIII. People over 65 eligible and those w/ specific diseases (ESRD)
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Primary Care?
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Preventitive care.
Internal Medicine, Fam. Med., Pediatrics |
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Secondary Care?
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Specialist-referred care. After a disease has been detected, secondary care services intialized.
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Tertiary Care?
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Highly specialized care administered to patients. Hi-tech & intensive care services.
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Licensure?
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Physicians, OTs, PTs, NP must be licensed by state.
Hospitals, Nursing Homes have to be licensed as well. |
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Certification?
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Hospitals must be certified by Medicare/Medicaid to collect reimbursement from them.
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Accreditation?
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voluntary process of institutional or organizational review in which a quasi-independent body created for this purpose periodically evaluates the quality of the entities work against pre-established written criteria.
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Governing Board
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Ultimately responsible for the hospital.
Typically run by members of the community and staff members. Hires the physicians. |
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Administration
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May have many administrators.
CEO responsible for implementing the policies and strategic directions set by the hospital's B.O.D. |
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Medical Staff
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Typically hired by the governing board.
i.e. radiologists, pathologists |
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Allied Professionals
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PT, OT, RHIA
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Support Staff
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HR, Admitting patients
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Reimbursement - Medicaid
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State and federal support.
Support the poor. |
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Managed Care
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Oversee the utilization of services.
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Capitation
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the basis on which the fed. gov't provides support for the training of health professionals. It is a payment system used in managed care in which provider is paid a fixed, predetermined amount on a regular basis for provision of all covered benefits to the insured individual.
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HMO
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Delivers and manages health services under a risk based arrangement. Usually receive monthly premium or capitation payment for each enrollee. Based on projection of how much patient will cost
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PPO
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Preferred Provider Org.
Arrangement b/w a provider network and a health insuer or self insured employer where providers accept payments less than traditional fee for service payment in return for a pontentially greater share of the patient market. |
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POS
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Point of Service Plan
An HMO plan that allows its members to use providers not on the org's rolls. Members must pay an added premium or out of pocket when serviced by these providers. |
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Indemnity plans
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The insurer pays usually on a fee for service for care received up to a fixed am. per episode of illness.
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DHHS
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Dept. of Health & Human Services
monitor health status evaluate effectiveness, accessibility and quality of personal and pop-based health services |
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CMS
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Centers for Medicaid/Medicare Services
... is within DHHS; also includes SCHIP. |
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CON
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Certificate of Need
Est. in 1974 Capital RW Expenditure program for hospitals, nursing homes, & other health facilities. |
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IDPH
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Regulate edical practioners and to promote sanitation.
Assess prevention and control of diseases to the public. |
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Skilled Nursing
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Nursing Home
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Intermediate Care
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for mentally retarded
Provides residnetial care and services for individuals with developmental disabilities |
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Hospice
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Medical care provided to persons with life expectancies of 6onths or less who elect to forgo standard treatment of their illness and decide to recieve only palliative care
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Home Care
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Medical and or personal care provided to individuals and families in their places of residence with the goal of promoting, maintaining, and or restoring health issues.
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PPS
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Planning Policy Statement
type of reimbursement system that is based on preset payment levels rather than actual charges billd after teh services gave been provided specifically. |
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BOK
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The collected resources, knowledge, and expertise within and related to a profession.
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COP (communitie of Prac.)
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Communities of Practice
The communities for those interested in clinical terminologies and vocabularies |
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CAHIIM
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Commission on Acccreditation of Health Informatics and Info Management Education
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Public Health (Local)
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Vaccinations
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Public Health (State)
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Surveillance & B
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