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100
A doctor, dentist, or nurse practitioner whose health care services are covered by a health insurance plan
What is a Health Care Provider
100
The Medicare plan that pays for ambulance transportation, preventative services such as certain lab tests, and physician visits
What is Medicare B
100
The second entity in the joint venture with the state governments that fund Medicaid
What is the federal government?
100
The traditonal method of paying for health care; where physicians are paid a fee for each service provided
What is fee for service?
100
John, a 66 yr old has been in the hospital 5 days with a CVA. He no longer qualifies for hospital care, but requires ongoing PT, OT, and ST. The most logical place for him to receive ongoing care is here
What is a skilled nursing facility or rehab center BONUS: What will pay for this service??
200
The monthly fee a person must pay for health insurance coverage
What is a premium
200
The part of Medicare that pays for prescripton drugs
What is Medicare D?
200
Who administers the Medicaid program
What is the individual states
200
The primary method of payment before the 1940's
What is private pay
200
Mary, the mother of 2 children is in school to become a nurse and only works part time. She has no health insurance. She tells you she cannot afford to take her children to the doctor. You give her information on this program
What is CHIP or SCHIP
300
the amount a person with insurance must pay each time they have an office visit, getting a prescription or before a hospital service
What is a co-payment
300
The part of Medicare that pays for hospice care, post-hospitalization skilled nursing care, and inpatient hospital services
What is Medicare Part A
300
The official name of the Medicaid program when it was added to the Social Security Act of 1965
What is Title XIX
300
A program that spreads the risk among a group
What is private health insurance?
300
You are working in a physician's office and notice the prescription given to your 80 year old patient is very expensive, and you know they are on multiple medications. As it is September, you question the patient to find out if she is in this phase of her plan
What is a coverage gap or doughnut hole?
400
the percent of the total bill paid by an insured person once the deductible is met
What is Coinsurance
400
The three types of Medicare Advantage plans
What are Medicare HMO, Medicare PPO, and Medicare private fee for service
400
This legislation authorized welfare-to-work states to create additional job opportunities to get people into jobs with health insurance and off Medicaid
What is the Balanced Budget Act of 1997
400
A set monthly fee paid to a health care provider for each member of the insurance group for a specified group of services.
What is capitation?
400
Edward has been in skilled care for IV antibiotics for 2 weeks. The antibiotic is to be discontinued tomorrow, but he cannot go home as also has dementia and no one to care for him. He will remain in the long term care facility. His method of payment will be this
What is private pay
500
the amount out-of-pocket an insured person must spend each plan year before the health insurance policy will begin to pay
What is a deductible
500
The method Medicare uses to determine the fees the government will pay for hospitalization
What are diagnosis related groups
500
This provides health insurance for children in families that do not qualify for Medicaid but cannot afford health insurance
What is CHIP or SCHIP.
500
the method of payment that encourages wellness and has no deductibles or copays
What is capitation?
500
Susan is a 35 year old with end stage renaldisease (ESRD). What type of health care coverage will she qualify for?
What is Medicare