Health Care Financial Management

Front 1

Patient-Centered Medical Home

Back 1

Partnership between primary care providers, patients, and patients' families to deliver comprehensive care over the long term

Front 2

Medical Tourism

Back 2

Travel to a foreign country to obtain normally expensive medical services at a steep discount

Front 3

Electronic Health Record/Electronic Medical Record

Back 3

Online version of patients' medical records that includes demographics, insurance information, dictations, medication and immunization histories, etc.

Front 4

Health Insurance Portability and Accountability Act (HIPAA)

Back 4

Set of federal compliance regulations enacted in 1996 to ensure standardization of billing, privacy, and reporting practices as institutions convert to electronic systems

Front 5

Meaningful use

Back 5

EHR technology has been implemented in a manner that improves the quality of the health care provided.

Front 6

Retail Health Care

Back 6

Walk-in medical services for basic preventive health care provided in a retail outlet, such as a pharmacy, by a licensed care provider

Front 7

Compliance

Back 7

The process of abiding by governmental regulations, whether in the provision of care, billing, privacy, etc

Front 8

Recovery Audit Contractor Program

Back 8

Program created under the Medicare Modernization Act of 2003 to identify and recover improper Medicare payments to health care providers

Front 9

Value-based purchasing

Back 9

Payment methodology designed to provide incentives to providers for delivering quality health care at a lower cost. The financial rewards come from funds being withheld by the payor; these funds are then redistributed on providers' achievement of specific performance measures

Front 10

Shared savings

Back 10

Payment strategy that offers incentives for providers to reduce health care spending for a defined patient population; these incentives are a percentage of the net savings realized as a result of provider efforts

Front 11

Prospective Payment System

Back 11

The payment system used by Medicare to reimburse providers a predetermined amount. Includes methods based on DRGs, APCs, a resource-based relative value scale (RBRVS), and resource utilization groups (RUGs)

Front 12

EMTALA

Back 12

Emergency Medical Treatment and Active Labor Act, also known as the patient anti-dumping law

Front 13

Group Purchasing Organizations (GPOs)

Back 13

Can negotiate cost discounts through large volumes

Front 14

HITECH Act

Back 14

Expanded HIPAA by providing incentives for providers to achieve meaningful use

Front 15

Accountable Care Organization (ACO)

Back 15

Voluntary group of health care providers who come together to provide coordinated care to a patient population in order to improve quality and reduce costs by keeping patients healthy and by reducing service duplication

Front 16

ICD-10

Back 16

The World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD) is a coding system for diseases that's used in the U.S. for health insurance claim reimbursement (U.S. currently uses ninth version). Tenth version assists in morbidity and mortality data reporting and accommodates advances in knowledge and technology.

Front 17

Medicare severity-adjusted diagnosis related groups (MS-DRGs)

Back 17

Has 25 major disease categories, 745 diagnosis related groups, and 3 subclasses of complications and comorbidities; intended to more closely align reimbursement to patient severity of illness

Front 18

Deficit Reduction Act of 2005

Back 18

Purpose was to reduce overall hospital costs by improving care, thus combining quality and cost control and improving equity