History of Healthcare reimbursement
These assist in institutions giving cost effective care. A patient who has this for a diagnosis of COPD exacerbation will have an average hospital stay of 3 days.
What is a critical pathway or clinical pathway?
These plans were designed so the HCP only ordered or prescribed things appropriate and necessary to the patient's condition.
What is a Managed Care Organization (MCO)?
This is a general type of managed care organization. Specific health care insurers include Blue Cross/Blue Shield and Aetna.
What is a Health Maintenance Organization (HMO)?
This model provides a framework for budget planning.
What is the Nursing Process?
This is a statistical measurement that refers to how ill your patients are and dividing them by the number of patients on your unit or institution.
What is the Acuity index?
Around the turn of the 20th century, this healthcare provider was primarily responsible for caring for patients.
Who is a doctor?
With this HMO, the patient at the time of care has the right to obtain service outside of the plan's network (at a higher cost absorbed by the patient).
What is the Point of Service (POS) plan?
This is where HCP receive payment for services provided. The more services they provide, the more money they make without regard to wasting either money or resources.
What is Fee-for Service?
This budget comprises the largest expenditure in health care organizations.
What is the Workforce or Personnel Budget?
This is the idea that fiscal responsibility is everyone's responsibility.
What is responsibility accounting?
Started in 1965, this health insurance was sponsored by the US government. It was begun for people over age 65. By 1972, this healthcare coverage was extended to younger people with certain disabilities such as CKD.
What is Medicare?
This plan was instituted in 1988 in a effort to cover certain drugs and healthcare expenses by those patients who have Medicare.
What is the Medicare Catastrophic Coverage Act (MCCA)?
In the 1980's the advent of this, made providers consider costs and resources by reducing both (cost containment).
What are Diagnosis Related Groups (DRG's)?
This is the simplest method of budgeting often used by health care organizations. It is calculated by multiplying yearly expenses by either the inflation rate or Consumer Price Index.
What is Incremental Budgeting?
This is the type of patient (i.e. cardiac, respiratory, neuro etc.), that a health care institution serves.
What is the case mix?
Established in 1965, this healthcare insurance is both federal and state health insurance plan that covers lower income patients, lower income families with children as well as lower income elderly.
What is Medicaid?
This is the nickname for the Patient Protection and Affordable Care Act passed in 2010. The nickname came from the person who instituted this act.
What is Obamacare?
Today, HCP must use this to justify and code diseases, signs & symptoms, and abnormal findings to get reimbursed by the insurance companies.
What is the International Classification of Diseases (ICD now 10th ed.)?
In this method of budgeting, a manager must justify their needs every fiscal year. This method is very labor intensive for managers.
What is zero-based budgeting?
This is a health care organization that money comes from a variety of sources, however, owners of funds that go toward the institution do not have any interest as an owner. Any profits made are put back into institutional expenses.
What is a not-for-profit organization?
This health care plan was implemented in 1929 as a response to teachers who worked at Baylor University in Dallas. These teachers were guaranteed 21 days in the hospital for a payment of $6 a year.
What is Blue Cross?
This is a voluntary program for prescription drug coverage for those patients who are on Medicare. This was passed in 2003.
What is the Medicare Prescription Drug, Improvement, and Modernization Act of 2003?
This is the percentage that Medicare part B pays after a patient has met their yearly deductible.
What is 80%? ( patient 20%).
This budget sets aside funds for elements such as broken toilets, light bulbs, or anything else related to the day to day costs of running an institution.
What is an operating budget?
Because of the prospective payment system and the need to contain costs, the average hospital stay has ________significantly.
What is decreased?