Private Health
The amount a patient must pay before their insurance starts to pay
What is a deductible
The part of Medicare that covers hospital stays and hospice
What is Part A
The 2 entities that fund Medicaid
What are the state and federal government
A hospital that provides only a certain type of therapeutic care, such as psychiatry or rehabilitation, or serves only certain types of patients, such as children.
What are specialty hosptitals
The alphanumeric string used to identify a diagnosis
What is a diagnosis code
The Medicare reimbursement system for home health care
What is Patient-Driven Groupings Model (PDGM)
The principle that the equitable distribution of health care is a social responsibility
What is social justice
The percentage a patient must pay toward their medical care after their deductible has been met
What is coinsurance
The part of Medicare that is administered by a private insurance company
What is Part C
The term used to represent the individuals payment of premiums, deductibles, and coinsurance
What is cost sharing
The person who answers to the board of directors and supervises all hospital operations
What is the CEO (Chief Executive Officer)
The number used to identify a health care procedure
What is a CPT code
The Medicare reimbursement system for Skilled Nursing facilities
What is the Patient-Driven Payment Model
The model that defines health as the absence of illness or disease.
What is the medical or biomedical model
Type of insurance plan that:
-Has no out of network benefits
-Requires a referral to see a specialist
-Requires a PCP
What is a HMO
The part of Medicare that is the prescription drug benefit
What is part D
The standard used to determine Medicaid eligibility
What is Federal Poverty Level
Prospective payment system used by Medicare for hospital care.
What is the Diagnosis Related Group (DRG) System
The type of payment system used for outpatient physical therapy
What is Fee for Service
A facility, or distinct part of one, primarily engaged in providing skilled nursing care and related services for people requiring medical or nursing care, or rehabilitation services.
What is a Skilled Nursing Facility (SNF)
The model that defines health as "a complete state of physical, mental, and social well-being, and not merely the absence of disease or infirmity.”
What is the biopsychosocial model
or
What is the definition of health according to the World Health Organization (WHO)
The type of insurance plan that:
-Has a network of providers
-Does not require referral from a specialist
-Has out-of-network benefits
What is a PPO
The part of Medicare that may include dental, vision and hearing
What is Part C
This important service is considered "optional" in the federally mandated core or basic medical services for state Medicaid programs
What is physical therapy
A single price for all health care services before, during, and after hospital care
What is a bundled payment
A concept not a place that uses a team-based care model led by a physician.
What is a patient centered medical home.
Groupings for prospective reimbursement under Medicare for home health agencies based on admission source, timing of the 30 day period, clinical grouping, functional impairment level, and comorbidity adjustment.
What is the Home Health Resource Group
The only variable of health care that the USA ranks number 1 compared to other industrialized countries.
What is health care spending per capita
George has a $1,000 deductible and a 10% co-insurance. He has met $975 of his deductible. His insurance was billed $100 for a physical therapy visit. The contracted amount is $50. The amount Joe has to pay
What is $27.50
The part of Medicare that has no premium as long as the individual has worked in the united states at least 10 years
What is Part A
A program that compliments the Medicaid program by offering insurance to children whose family income is too high to qualify for Medicaid and too low to afford private insurance.
What is the Children's Health Insurance Program (CHIP)
Medicare will not pay the extra costs associated with these
What are never events
Reduces the value of each unit billed after the first unit for outpatient physical therapy services
What is the Multiple Procedure Payment Reduction (MPPR)
The type of long-term care that requires a physician to certify that the patient requires daily skilled care by nursing 7 days per week and/or therapy staff 5 days per week.
What is a Skilled Nursing Facility (SNF)
Conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
What are social determinants of health?