What requirement did the Hill-Burton Act impose on facilities that received federal grants for modernization? Facilities were required to provide services free or at reduced rates to patients unable to pay for care. Medical group practices were formed to allow providers to share equipment, supplies, and personnel. National coordinating agencies for physician-sponsored health insurance plans were created. Universal health insurance was provided to those who could not afford private insurance.

Facilities were required to provide services free or at reduced rates to patients unable to pay for care.

What role do Third-party administrators (TPAs) play in the administration of health care plans? Clearinghouse for data submitted by government agencies. Medicare administrative contractor (MAC) for business owners. System of checks and balances for labor and management. Third-party payer (insurance company) for employers.

System of checks and balances for labor and management.

The problem-oriented record (POR) includes which of the following four components? Chief complaint, review of systems, physical examination, laboratory data Database, problem list, initial plan, progress notes Subjective, objective, assessment, plan Diagnostic plans, management plans, therapeutic plans, patient education plans

Database, problem list, initial plan, progress notes

Overview of Health Care Systems and Policies

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Cards in this deck(79)

What requirement did the Hill-Burton Act impose on facilities that received federal grants for modernization?

What role do Third-party administrators (TPAs) play in the administration of health care plans?

Major medical insurance provides coverage for _____ illnesses and injuries, incorporating large deductibles and lifetime maximum amounts.

What is the term for the percentage of costs a patient shares with the health plan?

Which legislation allows employees to continue health care coverage beyond the benefit termination date by paying appropriate premiums?

The Patient Protection and Affordable Care Act (PPACA) of 2010 resulted in the creation of a(n) _____?

What is a primary purpose of the patient record?

The problem-oriented record (POR) includes which of the following four components?

What is the term for the unique patient identifier used in electronic health records (EHR) to allow patient information to be created at different locations?

In which portion of the SOAP note is a patient's statement such as 'I haven't been able to sleep for weeks' documented?

In the SOAP format, where does the provider document the physical examination?

What is the intent of managed health care?

If an average risk score is 1.0 with a value of $1,500, what is the risk score monetary average for a 77-year-old patient with a 0.7 demographic risk factor and a 0.9 health status risk factor?

What happens to the remaining $20,000 when a Medical Center receives a $100,000 capitation payment and expends $80,000?

What is a nonprofit organization that contracts with and acquires the clinical and business assets of physician practices called?

Who is responsible for supervising and coordinating health care services for health insurance and managed care enrollees?

What term describes requirements created by accreditation organizations?

Which administrative procedure should a medical practice follow when it contracts with a managed care organization (MCO)?

Which is a consumer-directed health plan?

In managed care, what type of payment does a specialist receive when arranged by a primary care provider?

What is a contracted network of health care providers that provide care to subscribers for a discounted fee called?

What is an organization of affiliated providers' sites that offer joint health care services to subscribers called?

What is the managed care model that provides benefits to subscribers who are required to receive services from network providers called?

What is the managed care model that provides comprehensive health care services to voluntarily enrolled members on a prepaid basis called?

What is the managed care model that allows patients to use the managed care panel of providers or self-refer to out-of-network providers called?

What does a patient mean when they say, 'I haven't met my deductible yet, and I'm afraid that this procedure will cost a lot'?

What is a copayment?

What should you say to a patient who is unsure if they or their spouse is the policyholder?

River recently became insured through insurance offered at their employer. What roles does River have?

What is the term for a primary care provider who is responsible for supervising and coordinating healthcare services?

What is the method of financing managed care where providers accept pre-established payments for a length of time called?

What is the term for formal prior approval from an MCO for a patient to have a procedure done?

What is a written order by the primary care provider for treatment and evaluation of the patient by a specialty provider called?

What is the fee required by the health plan, paid to the provider at the time of service called?

What is the amount the insured must pay before insurance will provide coverage called?

What is the amount an insurance policyholder must pay to maintain insurance coverage called?

What is the percentage the patient pays for covered services after the deductible has been met called?

What healthcare coverage would Emmerson be eligible for if their parent was permanently disabled due to a service-related injury in the US Navy?

What health care program is Dakota eligible for after retiring at age 67 and losing group health insurance?

What is Charlie's role in a managed care plan if they review patient care plans and coordinate health care to improve patient outcomes?

Which of the following are types of consumer-directed health plans (CDHPs)?

Which organization reviews managed care plans and develops report cards to help consumers make informed decisions?

What are employees and dependents who join a managed care plan known as?

What type of plan involves employer contributions and requires employees to be more responsible for health care decisions and cost sharing?

Which program provides health care services to Americans over the age of 65?

Which act provided federal grants for modernizing hospitals that had become obsolete and required them to provide services to patients unable to pay for care?

Which amendment eased restrictions on preferred provider organizations (PPOs) and allowed subscribers to seek health care from providers outside the PPO?

Which entity did CMS authorize to perform utilization and quality control review of health care furnished to Medicare beneficiaries?

Which legislation included in ARRA established an Office of the National Coordinator for Health Information Technology (ONC) within HHS?

What is created when the cost of health care coverage is determined by employees' status, age, sex, and occupation?

Which plan was implemented to create flexibility in managed care plans, allowing patients to self-refer to out-of-network providers?

What is the name of the federal legislation enacted in 1981 that expanded the Medicare and Medicaid programs?

Which entity was established by Medicare to ensure the accountability of managed care plans in terms of objective, measurable standards?

Which organization is responsible for reviewing health care provided by managed care organizations?

What is a triple option plan also called?

What is the concept of combining health care with the financing of services provided called?

What type of HMO provides health care services to subscribers by physicians employed by the HMO?

What is a tax-deferred account used for qualified health care expenses where unused funds roll over from year to year called?

Which regulations govern privacy, security, and electronic transaction standards for health care information?

Where are performance measures developed by NCQA and used to evaluate managed care plans found?

Which legislation allows employees to continue health care coverage beyond the benefit termination date by paying appropriate premiums?

Which entity is responsible for the health of a group of enrollees and can be a health plan, hospital, physician group, or health system?

What is a physician fee schedule?

What is the voluntary process that a facility undergoes to demonstrate that it meets standards beyond those required by law?

Which of these includes the provision of preventive services?

What is a physician or health care facility under contract to a managed care plan called?

What is the amount for which the patient is financially responsible before an insurance policy provides payment called?

What type of insurance is purchased by individuals or families who do not have access to group health insurance coverage?

What is the global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient?

In a managed care plan, what role does the primary care provider (PCP) serve as?

What documents health care services provided to a patient and includes patient demographics and treatment history to facilitate continuity of care?

What is a health insurance company that provides coverage, such as BlueCross BlueShield, called?

What is a nonprofit organization that contracts with and acquires the clinical and business assets of physician practices called?

Which legislation amended the PPACA to implement health care reform initiatives such as increasing tax credits to buy health care insurance?

What is a contract between a policyholder and a third-party payer or government health program to reimburse the policyholder for medically necessary treatment?

What is sometimes required by managed care plans prior to scheduling elective surgery?

What is the term for a triple option plan used to exclude members who are sicker than the general population?

What type of plan allows patients to seek health care from any provider, and the health plan reimburses the provider according to a fee schedule?

What is a provision in a health or managed care plan that requires the policyholder or patient to pay a specified dollar amount to a health care provider for each encounter or medical service received?

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