MCO
oversight
ORGANIZATIONS
reimbursement
PTA's
100
healthcare plan plan that provides greatest freedom, few exclusions
What is FFS
100
imprisonment, loss of credentials, fines, loss of licensure
What is the result of non-compliance with oversight organization standards
100
TAX exempt, charitable organizations, profits returned to organization
What is NFP organizations
100
patient fee for service/prescription
What is copay
100
understand state practice acts, renew license by specified date, pay renewal fees
What is a Licensed PTA
200
MCO contracts with providers at discounted rate
What is PPO
200
CAPTE, JCAHO, CARF
What is VOLUNTARY ACCREDITATION ORGANIZATIONS
200
insurance employers offer at termination
What is COBRA
200
portion of cost paid by patient after deductible met
What is coinsurance
200
Degree from PIMA for PTA program
What is Associate of Occupational Studies Degree
300
pays for inpatient hospitals, inpatient rehab, SNF, home health, hospice
What is Medicare A
300
regularly evaluate and audit healthcare organizations for acceptable level of quality
What is Medicare, Medicaid, JCAHO, CARF
300
SCHIP, Medicaid, Medicare
What is Social Security Act established
300
amount individual pays before healthcare plan begins to pay
What is deductible
300
PTA that doesn't act in a reasonable and prudent manner
What is negligent PTA
400
guarantees equal opportunity for individuals with disabilities in employment, public transportation, public accommodations
What is ADA
400
gate keeper
What is a primary care physician
400
Make money from the delivery of health care
What is NFP and For profit healthcare organizations
400
65 or older, permanently disabled, end-stage renal disease
What is Medicare
400
an intentionally committed act to cause harm to another
What is intentional tort
500
pay for each test/procedure
What is FFS
500
gatekeeping is common in this type of MCO
What is HMO
500
compare care provided to guidelines, determine if reimbursable,
What is Utilization review
500
3rd party payers payers review to see if services meet these standards
What is UCR
500
MCO that encourages therapists to limit time with patients because of unknown future expenses
what is an HMO
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