Defintions
What is the term that describes as the failure to meet the standard of practice of an average qualified physician practicing in the same specialty.
Medical Negligence
What is an experience rating?
This means premiums are set by looking at the individual’s health status and history of prior claims
What does CMS stand for?
Centers of Medicare and Medicaid Services.
What services are covered under the Medical Legal Partnership (MLP) model?
Employment
Housing
Education
Legal Status
Medicare is the primary payer for Long Term Care in the US
False- Medicaid
What is The principle of ethics that deals with the way healthcare benefits are allocated is referred to as?
Distributive justice
What does the ACA require from employers with 50 or more full time employees?
Offer or pay a fee to the government.
The fee is meant to discourage employers from dropping employee health insurance, which they might be tempted to do since their employees could buy individual insurance through the health insurance exchanges
Medicare Part ___ covers Supplemental medical insurance—physician services, outpatient services, some preventive services – Financed by federal tax revenues and monthly premiums, deductibles, and copayments paid by beneficiaries
Part B
In a newspaper article. "Case Studies At Denver Health: ‘Patient Dumping’ In The Emergency Department Despite ....., The Law That Banned It.
What law did Denver Health Break?
EMTALA
Unpaid caregivers such as family members provides the most long term care in the US?
True
The flow of dollars from individuals and employers to health insurance plans is known as:
Financing
Which of the following provides health insurance to low-income children whose family income is above the Medicaid eligibility level in their state?
Child Health Insurance Program
What does Medicare Part D coverage include?
Prescription drug coverage—may receive through private drug plans or managed care arrangement – General federal tax revenues – Monthly premiums paid by beneficiaries – State payments for dual enrollees
A 75 yr old with a hx of stroke is paralyzed and is wheelchair bound with no family nearby. He is in need of IADLS and ADLS but does not want to leave his home. He family is requesting an HHA, but the member has private insurance. Should the member stay with the private insurance or switch to Medicaid and why?
Medicaid because it provides long term coverage.
Medicaid covers acute care, but provides no long-term care benefits
True
Active surveillance of the clinical activities of clinicians, and the denial of payment for services that are deemed unnecessary, is referred to as:
Utilization management
What is an HMO?
Which is cheaper, HMO or PPO?
Health Maintenance Organization. Vertical integration refers to consolidating under one
organizational roof and common ownership all levels of care, from primary to tertiary care, and the facilities and staff necessary to provide this full spectrum of care
HMO
What benefits does Medicare Part A include?
Hospital insurance, inpatient hospitalization, skilled nursing facility, home health care, hospice care – Financed through social security system
An individual decision to purchase a service, or a company's decision to hire an employee, are examples of which type of economics?
Microeconomics
Doing laundry, preparing dinner, taking medications are examples of ADLs
False, these are IADLS
ADLS- Feedings, dressing, bathing or showering, getting to and from toilet, getting in and out of bed or chair
Controlling the number of staff and equipment within a healthcare organization is which type of cost control method?
Supply Limits
What reform can be used To limit the amount that can be rewarded to plaintiffs (patients), place caps on attorneys fees?
Pay for Performance
Regarding health care economics, what are 2 examples of what would shift the demand for healthcare services?
The price of the health care service.
patients income
perceived quality of the healthcare service
Measuring practice patterns is one of the ways to improve quality of care. This is achieved by monitoring how well individual caregivers, institutions, and organizations are performing, which is assessed by process and outcome measures
True