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68 Cards in this Set

  • Front
  • Back
covered by policy
indivviduals who purchase the policy
health insurance company
covered services or benefits
services that are reimbursed by the insurance policy
durable medical equipment
first party
individual seeking health care
second party
third party
health insurance agency
16.1 to 17.8%
empolyer sponsered health insurance
insurance offered as benefit to full-time empolyees
who pays for e-s HI
both the empolyer and empolyee
payroll deducation
take out portion to pay for premiums
open enrollment
empolyee has the oppurtunity to switch to a new health insurance
the amount that the subscriber incurs before health insurance will pay for their part
flat dollar amount subscriber has to pay for specific health services at the time
center for medicare and medicaid services
dept. of health and human services
how oversee medicare
federal gov.
who oversees medicaid
federal and state
medicare A
provides mandatory coverage for impatient hospital care
what pays for medicare A
payroll taxes and general federal revenues
Medicare B
voluntary program paid for by the individual matched by general federal revenue: pt along with other out patients
medicare advantage
optinal health insurance greater choices from array of private health plan options
medicare D
part of the perscription plan
and BBA
health insurance program for indigent population and is jointly funded by the state and the federal government
state children's health insruance agency
retrospective reimbursment
pay after service
Fee-for Service
method of retospective reimbersment
prospective payment system
payments are established in advance
diagnosis related group
patient's diagnosis determines the amount the hospital will be paid: fixed payment based on the average
used to determine the reimbersment amounts
resource-based relative value scale RBRVS
replaced the fee-for service system: total work compeleted, cost to practice medicine, and malpractice insurance
medicare fee schedule
lists payments for thousands and is frequently used by third party payers for all their subsricbers
health maintenance organization
hmo do
provide loans and grants to form these entitles
staff model
hmo employes and operates the facilities where the service are provided
independent practice association IPA
individuals pysicians or groups form a legal entity that contracts with the HMO providing service w/o operating the facillites
Preferred provider organization
open managed care model- negotiates discounted fees w'networks in return for certain # of volume
primary care giver
decides whether a patient needs a specialist or nonroutine services
current procedural terminology
bba cap for pt
purpose of law and regulations
to insure competencey and the the money is being spent appropriately
body of rules that have binding legal force
criminal law
against the society
civil law
between two parties
failure to act as a reasonable prudent person
4 things they have to prove
1)owed legal duty2) fail to proivde standared care 3) suffered harm 4) that harm was a result of the pt
failure to meet professional standard of care
a decision that obligates an action
action requird to implement policies
centers for medicare and medicaid services
social security system
financial support and health care for the elderly, disabled, survivors, and those with low incomes
social secruity eligibility
40 pts 4x a year 10 yrs of work
medicare eligibility
65 or spous is 65, worked at a governmental agency, on dialysis or kidney transplant
medicare medical care part b
if you have to enroll when
7mnth period startes 3 months before and end 4 months after
generall enrollment
jan 1 to march 31
stop after dialysis
after transplant
36 months
effects of the tilt table
stimulates, facilitates, and provides response
benefits of direct access
earl intervention and rapid recovery, decrease chance of injuring it worse, and benefits everyone involved
accredits pta programs
makes the exam
recongises pt w/advance knwledge and skills, and experiences
APTA, occupatial, and speech/hearing
world conference
92 every 4 years
fee for service
determines the amount that will be paid for covered services during a period of time
usual, customary, reasonable range
claim that was paid in full without dispute