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48 Cards in this Set
- Front
- Back
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Through what are the majority (53%) of people insured in the US?
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Employer
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What is the average family insurance cost?
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Over $12,000 yearly
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How much has the cost of premiums increased since 2001?
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78%
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What percentage of companies offer health insurance to their employees?
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60%
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What insurance requires 2 transactions?
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Individual private insurance
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What insurance requires 3 transactions?
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Indemnity insurance
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What companies started life insurance policies in the early 1910s, and how much did they collect per week?
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Metropolitan Life
Prudential 10-25 cents per week |
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Why did private health insurance come about?
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Due to raising cost of hospital care and its increasing effectiveness
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What hospital started an insurance plan for hospital care, and when?
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Baylor University
1929 |
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What association established Blue Cross hospital insurance?
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American Hospital Association
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When was the 1st Blue Shield plan established and by whom?
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1939
California Medical Association |
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Which "blue" was controlled by physicians?
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Blue Shield
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Which "blue" was controlled by hospitals?
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Blue Cross
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Commercial insurers used what rating?
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Experience rating
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The Blues used what rating?
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Community rating
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What two groups in society received no benefit from private insurance?
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Poor
Elderly |
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When were Medicare and Medicaid introduced?
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1965
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What populations does Medicare cover?
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People over 65
People under 65 with certain disabilities People of all ages with end stage renal disease |
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How is Medicare funded?
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Taxes
General fund revenues Patient deductibles and copayments |
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Which part of Medicare is a hospital insurance plan?
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Part A
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How is Medicare Part A financed?
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Through social security taxes
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Who does Medicare Part A pay?
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Institutions
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Who makes the payments to hospitals in Medicare Part A?
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Intermediaries
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Who does Medicare Part B insure?
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Elderly for professional services provided in hospitals, nursing homes, private offices, patient's home; and services "incident to" the physician's care
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What is the name for administrators of Medicare part B?
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Carriers
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Medicare Part B reimburses under what system?
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Resource-based Relative Value Scale (RBRVS)
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RBRVS is divided into what 3 components?
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Physician's work
Practice expense Professional liability insurance |
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What allows Medicare to cover medical services provided by PAs in physician offices and clinics?
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"Incident to" services
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Who must personally treat the patient during their first visit in order to be reimbursed by Medicare?
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Physician
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What does Medicare Part D cover?
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Prescription medications
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What percentage of Medicare funds is spent on people during their final 60 days of life?
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13%
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What percentage of Medicare funds is spent on people during their final year of life?
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27%
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When was the Rural Health Clinic Services Act introduced?
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1977
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What act allows a clinic to be reimbursed by cost-based methodology instead of fee-for-service?
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Rural Health Clinic Services Act
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Under the Rural Health Clinic Services act, how is a PA reimbursed in relation to the physician?
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At the same rate as long as the PA is practicing in accordance with the law
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What are some populations of people who are covered by Medicaid?
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Aged, pregnant, blind, disabled, low income
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How is Medicaid funded?
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State program, funded through state and federal taxes
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When was CHIPS created?
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1997
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Children who are covered by CHIPS are in families with incomes of what?
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Less than 200% of federal poverty level, but above Medicaid income eligibility level
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How is CHIPS financed?
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Federal and state governments
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What is the only form of payment based on individual components of care?
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Fee-For-Service
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What is capitation payment?
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One payment is made for each patient's treatment during a specified unit of time
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What method of payment is most commonly associated with managed care?
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Capitation payment
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What is payment per day:per diem?
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Hospital receives a lump sum for each day the patient is in the hospital
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What payment method is a lump sum for each hospital admission?
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Payment per episode of hospitalization: Diagnosis-Related Groups
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What is payment per patient: Capitation?
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the hospital bears all the risks and the insurer bears no risk
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What is payment per institution: Global budget?
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A fixed payment is made for all hospital services for one year
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What is an example of payment per institution: global budget?
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the VA
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