Key Terms
Your insurance plan needs a _____ from your doctor in order for you to see a specialist.
Referral
Paying out-of-pocket is called?
Direct payment
What is one of the main factors causing a rise in healthcare costs?
Pharmaceutical Industries and/or the rise of elder population
A community facility that receives federal, state, and local tax exemptions in exchange for _______ benefit.
Community
Timmy has co-existing medical conditions that affect his health on a daily basis...
What is this called?
DOUBLE
Comorbidities
Every month, you get a letter in the mail asking to send in money for your insurance plan. What is this?
A premium
What are the three types of payment?
Government plan, direct payment, and private insurance
Which account forfeits funds at the end of the year, FSA or HSA?
What does it stand for?
Flexible Savings Account
A _____ ___ provides care for active military personnel and their dependents, veterans, and poor and older Americans.
Government Plan
Timmy's medicare Part D put a temporary limit on drug coverage which is not helping his condition...
This is called?
Coverage Gap
What are bundling payments?
When you make ONE payment for an episode of care.
John is a geriatric patient. What payment method is being used for his healthcare?
Government Plan
Healthcare cost containment eliminates unnecessary healthcare expenses...
TRUE or FALSE?
False
Which institution provides a community benefit and operates for a charitable purpose?
Voluntary Nonprofit
This part of a health insurance plan starts over each January, even if you haven't met it the previous year.
A deductible
What is the goal of a HRRP and what does it stand for?
Hospital readmission reduction program; trying to reduce the number of unnecessary readmissions into the hospital.
TRUE OR FALSE: The Prospective Payment system makes every service be paid for separately.
False
How do DRG’s categorize their patients?
By similar diagnoses.
What is a Proprietary Institution?
A for-profit educational institution
What is typically better to have, a low premium and high deductible or a high premium and low deductible?
Low premium, high deductible (deductible may not be used)
What does a federally qualified healthcare center provide care to?
Underserved populations
What happened to medical costs before a PPS plan and why?
The prices kept going up because hospitals were not being efficient and just made patients pay based on actual costs reported.
Improving patient safety, patient outcomes, and quality of care for all people are all goals of what?
Health Care Reforms
What are the three government plans?
Medicare, Medicaid, and CHIP
Your deductible is $1,500. Your coinsurance is 80/20. Your co-pay for specialist visit is $50. You already have $600 towards your deductible.
You broke your ankle, and you need to see a specialist. For all of your visits the total comes up to $1,200.
How much do you pay?
DOUBLE
$960