Social Science

Match the health care definition with the term
(Points : 13)

Potential Matches:

1 : Cost sharing

2 : Managed Care Organizations (MCO)

3 : Fee-for-Service (FFS)

4 : Diagnosis Related Group (DRG)

5 : Cultural Competency

6 : Capitation

7 : Prospective Payment System (PPS)

8 : Pay-for-performance

9 : Centers for Disease Control (CDC)

10 : Public Health

11 : Explanation of Benefits (EOB)

12 : Nostrum

13 : Gatekeeping

Answer

[removed] : Managed care’s way of classifying patients by diagnosis, average length of hospital stay, and therapy received

[removed] : Summarizes what the insurance company paid the provider, how much the patient owes, and provides an up-to-date status of the patient’s annual deductible and out of pocket expenses

[removed] : Employees become part of their employer’s group insurance plan and the employer subsidizes the monthly premiums

[removed] : Emphasized environmental sanitation to stop the spread of epidemic diseases

[removed] : Each individual service or treatment is paid and billed separately

[removed] : A derogatory term for a medicine, especially an ineffective one, prepared by an unqualified person

[removed] : Involves bundled payments when physicians are paid for a series of treatments that are not billable individually

[removed] : Preventing unnecessary specialized care

[removed] : Global mission of health protection, prevention, and preparedness

[removed] : Practice of recognizing that different groups have unique health experiences and needs

[removed] : Enter into contracts with hospitals and healthcare professionals to provide healthcare to the beneficiaries in exchange for a negotiated rate per patient

[removed] : Amount of payment is determined prospectively, before the service is rendered

[removed] : Reimbursement models aimed at improving the quality, efficiency, and overall value of health care

Match the real word example with the term
(Points : 13)

Potential Matches:

1 : Nostrum

2 : Fee-for-Service

3 : Public Health

4 : Capitation

5 : Diagnosis Related Group (DRG)

6 : Gatekeeping

7 : Prospective Payment System (PPS)

8 : Pay-for-Performance

9 : Cost Sharing

10 : Explanation of Benefits (EOB)

11 : Managed Care Organization (MCO)

12 : Cultural Competency

13 : Centers for Disease Control (CDC)

Answer

[removed] : Hospitals, skilled nursing facilities and home health agencies are reimbursed on an “episode of care basis”

[removed] : Dr. Thomas exams a patient named Jan. Jan’s health insurance provider is Blue Cross Blue Shield. Services provided included a Chest X-ray, yearly physical, and removal of a mole. Dr. Thomas receives reimbursement for each service rendered

[removed] : Dr. Thomas exams a patient named Jen. Jen’s health insurance provider is HealthPlus of Michigan. Services provided included a yearly physical, removing a mole and ordering of labs and chest x-ray. Dr. Thomas receives reimbursement based on a contracted discounted rate

[removed] : Jan receives a report from the health plan listing the blood work, chest x-ray and physical she received at her primary care physician’s office

[removed] : Mr. Jenkins owns a hardware in 1880s and starts to treat patients

[removed] : Dr. Thomas receives the same amount per patient per month whether the patient is receiving services or not

[removed] : Jan goes to the primary care physician in order to receive a referral to a specialist

[removed] : Jan is in severe pain evidenced by Nursing assessment of raised blood pressure, facial grimacing, and holding abdomen. However, she does not complain of pain

[removed] : Dr. Thomas reports to this entity that she has diagnosed a patient with Tuberculosis

[removed] : Jan is employed by ACME Tile, receives health insurance as a benefit and contributes $100/month to the premium

[removed] : Promotes a Youth advertising campaign to promote healthy eating and exercise

[removed] : Patient presents to the ER with COPD and is admitted to the hospital. The hospital is reimbursed based on the COPD Diagnosis

[removed] : Dr. Thomas educates and advises patients on quitting smoking, exercise, and health eating. Dr. Thomas receives reimbursement for meeting quality measures

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