Pt Test 2

Front 1

insured

Back 1

covered by policy

Front 2

subscriber

Back 2

indivviduals who purchase the policy

Front 3

insurer

Back 3

health insurance company

Front 4

covered services or benefits

Back 4

services that are reimbursed by the insurance policy

Front 5

DME

Back 5

durable medical equipment

Front 6

first party

Back 6

individual seeking health care

Front 7

second party

Back 7

provider

Front 8

third party

Back 8

health insurance agency

Front 9

uninsured

Back 9

16.1 to 17.8%

Front 10

empolyer sponsered health insurance

Back 10

insurance offered as benefit to full-time empolyees

Front 11

who pays for e-s HI

Back 11

both the empolyer and empolyee

Front 12

payroll deducation

Back 12

take out portion to pay for premiums

Front 13

open enrollment

Back 13

empolyee has the oppurtunity to switch to a new health insurance

Front 14

deductible

Back 14

the amount that the subscriber incurs before health insurance will pay for their part

Front 15

copay

Back 15

flat dollar amount subscriber has to pay for specific health services at the time

Front 16

center for medicare and medicaid services

Back 16

dept. of health and human services

Front 17

how oversee medicare

Back 17

federal gov.

Front 18

who oversees medicaid

Back 18

federal and state

Front 19

medicare A

Back 19

provides mandatory coverage for impatient hospital care

Front 20

what pays for medicare A

Back 20

payroll taxes and general federal revenues

Front 21

Medicare B

Back 21

voluntary program paid for by the individual matched by general federal revenue: pt along with other out patients

Front 22

medicare advantage

Back 22

optinal health insurance greater choices from array of private health plan options

Front 23

medicare D

Back 23

part of the perscription plan
and BBA

Front 24

medicaid

Back 24

health insurance program for indigent population and is jointly funded by the state and the federal government

Front 25

SCHIP

Back 25

state children's health insruance agency

Front 26

retrospective reimbursment

Back 26

pay after service

Front 27

Fee-for Service

Back 27

method of retospective reimbersment

Front 28

prospective payment system

Back 28

payments are established in advance

Front 29

diagnosis related group
DRG

Back 29

patient's diagnosis determines the amount the hospital will be paid: fixed payment based on the average

Front 30

case-mix

Back 30

used to determine the reimbersment amounts

Front 31

resource-based relative value scale RBRVS

Back 31

replaced the fee-for service system: total work compeleted, cost to practice medicine, and malpractice insurance

Front 32

medicare fee schedule

Back 32

lists payments for thousands and is frequently used by third party payers for all their subsricbers

Front 33

HMO

Back 33

health maintenance organization

Front 34

hmo do

Back 34

provide loans and grants to form these entitles

Front 35

staff model

Back 35

hmo employes and operates the facilities where the service are provided

Front 36

independent practice association IPA

Back 36

individuals pysicians or groups form a legal entity that contracts with the HMO providing service w/o operating the facillites

Front 37

Preferred provider organization

Back 37

open managed care model- negotiates discounted fees w'networks in return for certain # of volume

Front 38

PCP

Back 38

primary care giver

Front 39

gatekeeper

Back 39

decides whether a patient needs a specialist or nonroutine services

Front 40

CPT

Back 40

current procedural terminology

Front 41

bba cap for pt

Back 41

1740

Front 42

purpose of law and regulations

Back 42

to insure competencey and the the money is being spent appropriately

Front 43

law

Back 43

body of rules that have binding legal force

Front 44

criminal law

Back 44

against the society

Front 45

civil law

Back 45

between two parties

Front 46

negligence

Back 46

failure to act as a reasonable prudent person

Front 47

4 things they have to prove

Back 47

1)owed legal duty2) fail to proivde standared care 3) suffered harm 4) that harm was a result of the pt

Front 48

malpractice

Back 48

failure to meet professional standard of care

Front 49

policy

Back 49

a decision that obligates an action

Front 50

procedure

Back 50

action requird to implement policies

Front 51

CMS

Back 51

centers for medicare and medicaid services

Front 52

social security system

Back 52

financial support and health care for the elderly, disabled, survivors, and those with low incomes

Front 53

social secruity eligibility

Back 53

40 pts 4x a year 10 yrs of work

Front 54

medicare eligibility

Back 54

65 or spous is 65, worked at a governmental agency, on dialysis or kidney transplant

Front 55

medicare medical care part b
enrollment

Back 55

58.50

Front 56

if you have to enroll when

Back 56

7mnth period startes 3 months before and end 4 months after

Front 57

generall enrollment

Back 57

jan 1 to march 31

Front 58

stop after dialysis

Back 58

12months

Front 59

after transplant

Back 59

36 months

Front 60

effects of the tilt table

Back 60

stimulates, facilitates, and provides response

Front 61

benefits of direct access

Back 61

earl intervention and rapid recovery, decrease chance of injuring it worse, and benefits everyone involved

Front 62

capte

Back 62

accredits pta programs

Front 63

fsbpt

Back 63

makes the exam

Front 64

abpts

Back 64

recongises pt w/advance knwledge and skills, and experiences

Front 65

trialliance

Back 65

APTA, occupatial, and speech/hearing

Front 66

world conference

Back 66

92 every 4 years

Front 67

fee for service

Back 67

determines the amount that will be paid for covered services during a period of time

Front 68

usual, customary, reasonable range

Back 68

claim that was paid in full without dispute