Addressing Health Disparities: Cultural Proficiency
Managing Costs and Revenue + Financing Healthcare
Ethics and Law
Fraud and Abuse
100
The process of dividing the total market into groups or segments that have relatively similar needs for products and services (e.g. Demographic, Geographic, Psychographic, Situational, Behavioral)
What is Segmentation?
100
Significant gaps or differences in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population
What is Health Disparity?
100
The amount of money a policy holder is required to pay per month to purchase health insurance.
What is Premium?
100
Constitution, Legislative body, Executive orders, and Courts
What are the primary sources of American Law?
100
Billing for services not performed; Falsifying a diagnosis; Billing for a more costly service than performed; Accepting kickbacks for patient referrals; Prescribing medicines that are not medically indicated or for use by people other than the patient
What are the Major Types of Healthcare Provider Fraud
200
It seeks to satisfy customer needs through profitable relationships by creating, communicating, and delivering customer value in selected markets.
Billing for services rendered but no payment is received
What is Bad Debt?
200
Confidentiality, Right to refuse care, Self-determination, Emergency treatment even without ability to pay
What are the rights of patients?
200
Primary civil remedy for fraudulent and improper healthcare claims
What is The False Acts Claim?
300
Application of commercial marketing principles and techniques to influence behavioral change, of a specific target audience, in order to promote public health for the benefit of society as a whole.
What is Social Marketing?
300
The ability and willingness to respond respectfully and effectively to people of all cultures, classes, races, ages, ethnic backgrounds, and religions in a manner that values all
What is Cultural Competency?
300
Key provision - residents with incomes at or below 138% of the Federal Poverty Level
What is Medicaid Expansion?
300
Federal law over State law
What is Federal Preemption?
300
Sherman Act, Clayton Act and Federal Trade Commission (FTC) Act
Which Acts form the basis of the Antitrust Laws?
400
All the technology, both hardware and software, used to capture, store, process and transport information in digital form
What is Information Technology?
400
Workforce Diversity, Public Policy, Multilingual Services and Support Materials, and Evaluation and Research
What are the Cultural Proficiency Initiatives?
400
Requires hospitals to screen and stabilize (treat) each and every patient that comes into the hospital emergency department seeking care
What is the EMTALA of 1986?
400
Requires hospitals that participate in Medicare must provide screening examinations and treatment in their ER unless they can prove that a patient requested transfer after being fully informed of EMTALA
What are Provider Responsibilities?
400
Strict liability statutes that do not require proof of intent, nor do they have regulatory safe harbors that give rise to gray areas
What are Stark I and II Physician Self-Referral Law
500
Digitized X-rays, CT scans, etc through picture archiving and communications systems
What is an example of "Informational" role of Health IT?
500
Recruitment of diverse staff , respectful care that is compatible with the patients’ cultural health beliefs, language assistance services
What are some of the provisions of CLAS (The National Standards on Culturally and Linguistically Appropriate Services)?
500
Independent Practice Association
What is the most flexible HMO for participating physicians?
500
The right to be treated with fairness and dignity by their employers, be protected from sexual or other types of harassment, generally be able to excuse themselves from patient care with which they disagree (although this is under litigation at present)
What are the rights of the healthcare providers?
500
The Presidents newest tool against fraud and abuse concerning Medicare and Medicaid claims
What is HEAT (Health Care Fraud Prevention and Enforcement Action Team)