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27 Cards in this Set

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APN
Advanced-Practice Nurse: a general name for nurses who have education and clinical experience beyond that required of an RN
Allied Health
the science related to health care, and has responsiblity of health or related services
Generalist
physicians trained in family medicine/general practice, general internal medicine, and general pediatrics
Specialist
physicans in nonprimary care specialties, treat problems that occur less frequently, require additional training
LPN
Licensed Practical Nurses- must complete a state approved program in practical nursing and take a national written exam
NPP
Nonphysician Practictioner- clinical professional who practice in many of the areas in which physicians practice but do not have an MD or a DO degree
Nurse pracitioner
(NP) an area of specialization for APNs that work mainly in primary care settings
Osteopathic medicine
practiced by DOs, emphasizes the musculoskeletal system of the body such as correction of joints or tissues
PA
Physicians Assistant- part of the health care team who work in a dependent relationship with a supervising physician to provide comprehensive care
RN
registered Nurse- must complete and associates degree, a diploma program, or a bachelor of science in nursing degree
administrative information systems
designed to assist in carryin out finacial and administrative support activities such as payroll, scheduling, etc.
clincial information systems
the organized processing, storage, and retrival of info to support patient care delivery
medical practice guidelines
systematically developed protcols to assist practictioners in delivering appropriat health care for specific clinical circumstances
technology assessment
the evaluation of medical technology to determine its safety, effectiveness, feasability, and cost effectiveness
telemedicine
the use of advanced telecommunication and computer technology to provide health care at a distance
beneficiary
the insured, also known as enrollee
capitation
the provider is paid a fixed monthly sum per enrollee, often called a per member, per month payment
coinsurance
the ratio of cost sharing between the insurance plan and the insured
copayment
the amount that the insured has to pay out of pocket each time health services are received after the deductible has been paid
deductible
the amount the insured must first pay before any benefits by the plan are payable
cost sharing
purpose is to reduce the misuse of insurance benefits and control the utilization of health care services. Three main types: premium cost sharing, deductibles, copayments
means-tested program
when people must qualify based on assets or income, which must be below the threshold levels established. ex: medicaid
Medigap
supplemental insurance policies which cover all or a portion of medicare deductible and copayments
per diem
daily
prospective reimbursement
uses certain preestablished criteria to determine in advance the amount of reimbursement
retrospective reimbursement
historical cost are used to determine the amount to be paid
third-party payers
insurance companies, MCOs, blue cross blue shield, and the government