Pf Allied Health Lessons 1-3

Front 1

Health Care System

Back 1

A group of people, agencies, and/or institutions that provide health care services to individuals in a variety of settings

Front 2

Health Care Professionals

Back 2

The individuals who wish to care for the people seeking to improve their health status

Front 3

Ambulatory Care Centers

Back 3

Also known as Community Centers, provide health care consultations, treatment, and mediation using advanced medical technology. Outpatient basis

Front 4

Acute Care Hospitals

Back 4

Institutions that provide care for individuals who have a disease that comes on quickly or that lasts for a short period of time as well as injuries.

Front 5

Proprietary

Back 5

For profit

Front 6

Charity Based

Back 6

Non-profit

Front 7

Oncology

Back 7

Care for patients with cancer

Front 8

HMO

Back 8

Health Maintenence Organization

Front 9

Palliative Care

Back 9

Hospice care- critically ill

Front 10

Examples of public insurance:

Back 10

Medi-caid/Medi-cal

Medicare

Affordable Care Act (ACA)

Front 11

Examples of Private Insurance:

Back 11

PPOs

HMOs

POS

Front 12

Deductible

Back 12

Minimum amount that a person may pay out of pocket before health insurer will pay any expenses.

Front 13

Coinsurance

Back 13

Splitting the cost between individuals and their insurance carrier

Front 14

4 Major Government Health Insurance Programs

Back 14

Medicare

Medicaid

Tricare

Children's health insurance program- (CHIP)

Front 15

Medicare Part A

Back 15

Plan in which you're automatically enrolled when you apply for Medicare-Hospital insurance plan

Front 16

Medicare Part B

Back 16

Covers services and supplies that are medically necessary to treat your health condition. The Part B is your medical insurance plan.

Front 17

Medicare Part C

Back 17

Also known as Medicare Advantage Plan, enables beneficiaries to select a plan that includes supplemental insurance. Covers out-of-pocket costs not covered by part A & B. Must participate in A&B to get C

Front 18

Medicare Part D

Back 18

Medicare Rx drug benefit, a US federal government program that subsidizes the costs of Rx drugs & Rx drug insurance premiums for medical beneficiaries.

Front 19

Medicare Part A includes:

Back 19

Inpatient hospital coverage, SNFs, nursing home care, and hospice

Front 20

Medicare Part B includes:

Back 20

Outpatient services such as labs and doctor visits, DME, or any medical equipment used in the home to aid in better quality of living. Can also cover ambulance & preventative services

Front 21

DME

Back 21

Durable Medical Equipment

Front 22

True/False: Medicare Part D can only be purchased with Part C

Back 22

False: Can be purchased separately as only MC part D or in addition to MC Part C

Front 23

DRGs

Back 23

Diagnosis-Related Groups

Front 24

Formula to calculate reimbursement for health care providers in acute care settings (hospitals)

Back 24

DRGs

Front 25

What are the 2 types of DRGs?

Back 25

1. Principle DX

2. Secondary DX

Front 26

Principal DX

Back 26

The primary condition that led to the patient being admitted to the hospital

Front 27

Secondary DX

Back 27

Complications that may affect the patients course of treatment or prolonging the length of the patients hospital stay.

Front 28

What is Medicaid

Back 28

Largest source of funding for health insurance for low income families in the US. Funded by both the federal and state government, though it's managed at only the state level

Front 29

How do you qualify for Medicaid?

Back 29

Must earn salary below poverty level-

Individual: $14,000/year or less

Family of 4: $29,000/year or less

Front 30

What is CHIP?

Back 30

Designed for qualified families with children who don't have health insurance coverage. Don't pay for health coverage but may be responsible for co-pays. Pregnant women may also qualify for prenatal services under this

Front 31

Who manages and regulates Tricare?

Back 31

Department of Defense

Front 32

What are the 2 types of private health insurances?

Back 32

HMOs and PPOs

Front 33

PPO

Back 33

Preferred Provider Organization

Front 34

What is IPAB?

Back 34

Independent Payment Advisory Board

Front 35

What are ACOs?

Back 35

Accountable Care Organizations