Gerontological Nursing Cert Review

Front 1

3 types of current healthcare reimbursement

Back 1

Social insurance
Private insurance
Means-tested-insurance

Front 2

Medicare is what type of insurance?

Back 2

Social insurance.

Front 3

Most working adults have what type of insurance?

Back 3

Private insurance.

Front 4

Medicaid and disability insurance, which includes regardless of age those poor or disabled meeting certain requirements.

Back 4

Means tested insurance.

Front 5

When a physician writes off the difference of original charge and what Medicare pays it is called:

Back 5

"takes assignment"

Front 6

Enacted to:
1. develop tools to collect data on pts that would determine how Medicare is reimbursed
2. develop training and standards for LTC and home health care agencies to improve pt care

Back 6

Omnibus Budget Reconcilation Act (OBRA)

Front 7

Mandates use of standardized assessment tools for LTC facilities. Includes Resident Assessment Intruent (RAI), MDS and RAP

Back 7

Health Care Financing Administration (HCFA)

Front 8

Restructured Medicare Part A in 1996 to offer managed care options and change reimbursement in ambulatory care centers, LTC facilities, home health agencies, and rehab hospitals to a prospective payment system (PPS)

Back 8

Balanced Budget Act

Front 9

Allows:
1. parents to insure dependent children until age 26
2, prohibits insurance co from denying dependent children under 19 insurance due to pre-existing conditions
3. elimante copays for preventive health services

Back 9

Affordable Healthcare Act (passed 2010)

Front 10

Covers hospital and skilled nursing care.
Inpatient deductible for each hospital admission.
Skilled care is paid at 100% for 20 days.
21-100 days = copay
> 100 days (and hospital stay of d days) = pt 100% responsible

Back 10

Medicare Part A

Front 11

Pts pay a monthly premium. Covers medically necessary physician services, oupt care, output therapies, diagnostic test, med equipment, prosthetics, dialysis, ER, transplant, some med supplies.

Back 11

Medicare Part B

Front 12

Helps cover prescription drugs. Currently pt pa monthly premium and after deductible met scripts are covered until $2930. Then pt falls into "donut hole" pays 100%?? until $4700 met. Then percentage changes.

Back 12

Medicare Part D

Front 13

Private insurance plans that cover the 20% of uncovered charges that Medicare does not pay.
Must be one of 10 standard types and labeled A-J

Back 13

Medigap or Medicare supplemental insurance

Front 14

Options extended from traditional Medicare to include HMO, POS, PPO.

Back 14

Mediare Plus Choice

Front 15

Joint federal and state program for poor.
States set individual eligibility criteria within federal minimum standards.

Back 15

Medicaid and Children's Health Insurance Program (CHIP)

Front 16

Refers to amount that pts have to pay for healthcare services not covered by any ins plan

Back 16

Out-of-pocket fee-for-services

Front 17

Specific cost or payment per day for specific services

Back 17

Per diem payment

Front 18

Pt pays monthly amount for the service and then a small copay each time service is used.
Idea is to provide preventive and curative crd, decreasing the log-term expense of undiagnosed med issues

Back 18

Managed care organizations
(Health Maintenance Organizations {HMOs}

Front 19

Predetermined reimbursement based on pt acuity and staff needed to care for pt.
Medicare and Medicaid use this in skilled nursing and rehab settings

Back 19

Resource utilization groups (RUGs)

Front 20

Healthcare professionals paid by the federal government to review care given to Medicare pts.

Back 20

Peer review organizations (PORs)

Front 21

Healthcare providers selected by a third part to deliver care to a selected group at a reduced or preset rate

Back 21

Preferred provider organizations (PPOs)

Front 22

A term applied to older adults reducing their assets to become eligible for Medicaid

Back 22

Spending down

Front 23

Brought these changes: emphasis on quality of life/care, expectations of ADL's maintained or improved, assess for individual care plan, 75 hrs of training/testing for staff, rights to remain in NH (exclusions accepted), opportunities for MH pts, Cert standards for NH, right to family council and maintain personal funds

Back 23

Omnibus Budget Reconciliation Acts (OBRA)

Front 24

This is a Medicare Part A covered stay that has started on or after the most recent admission/entry or reentry to the nursing facility.

Back 24

Most Recent Medicare Stay

Front 25

Skilled Nursing Facility stays billable to Medicare Part A. Does not include stays billable to Medicare Advantage HMO plans.

Back 25

Medicare Covered Stay

Front 26

New admission: Day 1 of Medicare Part A stay. Readmission: Day 1 of Medicare Part A coverage after readmission following a discharge.

Back 26

Current Medicare Stay

Front 27

Theory in which a person's personality is visualized as oriented toward either the external or internal world. People are viewed as either extroverted or introverted.

Back 27

Jung's Theory of Individualism

Front 28

Theory that focuses on a life span approach from birth to death.

Back 28

Erikson's Eight Stages of Life

Front 29

Eriksons seventh stage

Back 29

Generativity versus Self-absorption

Front 30

Ericksons eighth stage

Back 30

Stagnation and ego integrity versus despair

Front 31

Theory that describes pts as self-care participants.
Helpful in planning care for older people because it focuses on maintaining independence

Back 31

Orem's Self-Care Theory

Front 32

Theory that defines pt as force field that interacts with other energy sources in the environment.
Nurse is responsible for promoting synergistic actions.

Back 32

Roger's Force Field Theory

Front 33

Theory that pts are in constant con act with a dynamic environment.
Goal of nursing is to promote pts innate and acquired mechanisms for adaptation to health and illness.

Back 33

Roys Adaption Theory