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31 Cards in this Set
- Front
- Back
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Name the 4 basic components of the U.S. HC Delivery system.
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1. Payment 2. Financing 3. Insurance 4. Delivery |
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True/False: the U.S. HC System is a truly integrated dynamic system.
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False |
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What is moral hazard?
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Once people have insurance they will use hc services more than if they had to pay out-of-pocket. |
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What was considered a major turning point in US health policy?
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1965 creation of Medicare and Medicaid
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Name the services included in the continuum of health care as we know it now
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Preventive Care Primary Care Specialized Care Chronic Care Long Term Care Subacute Care Acute care Rehab care End of Life Care
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These are the 5 diminsions of access to health care |
What are Availability, Accessibility, Affordability, Accommodation, and Acceptability |
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This is a deterrent to access in our U.S. Health Care System. |
What is a non-insured individual? |
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The attitudes and perceptions that health Service providers and population have Toward one another
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What is Acceptability? |
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The relationship between location |
What is Accessibility? |
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The relationship between amount and type of services provided and required |
What is Availability? |
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The consumption of economic resources expended on delivery of health care |
What is GDP (gross domestic product)? |
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Measures annual changes in economy to compare medical inflation to general inflation in the economy |
What is CPI (Consumer price index)? |
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Third party payment, growth in technology, Increase in elderly population, defensive Medicine, and waste/abuse |
What are reasons for HC cost escalation? |
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Co-payments, deductibles, and Shared premium costs |
What is demand-side cost- sharing containment of HC costs? |
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The US antitrust laws prohibit business practices stifling competition among providers represent this kind of cost- containment |
What are supply-side incentives? |
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This is a listing of descriptive terms and numbers for billing/reporting medical services and procedures to third-party payers |
What are CPT-4 Codes? |
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This rule determines how many units to bill for when rendering PT services |
What is the rule of 8’s? |
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This is the number of units a PT can bill for 22 minutes of PT. |
What is 1 unit? |
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Known to be effective in improving health outcomes, based on evidence or professional standards or expert opinion, and is the most appropriate intervention considering potential benefits and harms care |
What is medical necessity? |
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You must comply with these two things in order to be in adherence with general billing requirements. |
What are State Practice Act Rules and Regulations and the Insurance Plan (contract)? |
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These organizations administer and regulate Medicare benefits |
What are fiscal intermediaries, specifically Medicare Administrative Contractors (MACs) |
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The eligibility requirements for Medicare |
What is 65y/o, declared permanently Disabled by SS for 24 months, ESRD? |
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The two main Medicare plans and what they cover |
What is Part A: Inpt hospital care SNFs HH care Inpt rehab facility Hospice Part B: Outpt, HH, PT/OT/SLP in SNFs, DME, Prosthetics/ |
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The Medicare Plans that cover prescriptions drugs |
What are Medicare parts C and D? |
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Without any further cost-containment policies, Medicare is predicted to run out of funds by this year |
What is 2018? |
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The acute care setting uses this type of reimbursement |
What is the prospective payment System and DRGs? |
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This assessment tool is the most commonly used tool in rehabilitation hospitals |
What are FIMS? |
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The MDS assessment uses RUGS to determine reimbursement in this setting |
What is SNF? |
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This is the number one restriction of reimbursement from Medicare |
What is homebound? |
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This is the type of reimbursement used in an outpatient PT clinic |
What is fee-for-service reimbursement? |
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These are the 4 basic components of Health Care Delivery |
What are financing, insurance, delivery, and payment? |
