Reimbursement
Avoidable patient problems for which hospitals are not reimbursed by insurance
Never Events
Insurance type that restricts patients to in-network providers. Out of network providers are costly to patient
PPO
Payment for a service upfront
Prospective
State Health insurance for children not covered by Medicaid
CHIP
Focus is on the patient and the individual's particular health care needs.
Patient-centered care
Special approval from primary care provider required by HMOs and POS insurance companies before a patient can see a specialist provider
Referral
Insurance type that provides free or low- cost preventative services in their plan
HMO
Payment from a source other than the patient
Third-party payer
Insurance plan that is administered jointly by federal and state government
Medicaid
Services and tools designed to help nurses promote an optimal professional work environment and support their professional and personal development.
Workforce advocacy
Review required by some insurance companies before agreeing to pay for certain procedures or medications
Prior authorization
Lump insurance payments based on specific patient diagnoses
DRG
Payment for a service after the fact
retrospective
Insurance Plan that is federally administered
Someone who reports workplace conditions that he or she believes to be unsafe or illegal
Whistleblower
Evaluation mandated by government that surveys communication, responsiveness, pain mgmt, education, cleanliness, dch teaching, overall rating
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
Prescription drug coverage through a federally funded insurance program
Medicare Part D
Synonym for Universal Health Care
Single payer system
Insurance for members of the US military, their partners, and dependents
Tricare
A model of nursing practice designed to integrate core values and beliefs that professional practice embraces, as a means of achieving quality care
Shared Governance
Admission to a hospital within 30 days of discharge
Percentage of uninsured individuals in the US in 2022
8%
Financial incentives to providers and hospitals for providing quality care
Value Based care
Provides care for Veterans
Veteran Healthcare
Neumann University's Nursing program is accredited by what organization
ACEN