Term
| Who pays the majority of healthcare costs in the US? |
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Definition
| The Taxpayers aka the ones who pay for medicare and medicaid |
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Term
| What are the causes of rising healthcare costs? |
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Definition
-aging population
-expanding medical technology
-rising expectations in health care
-waste and abuse of the system
-defensive medicine and malpractice
-2008 recession
-cost to meet regulatory standards |
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Term
| What are the differences between prospective and retrospective payment? |
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Definition
-retrospective: bills filed after care
-prospective: bill filed before care
-retrospective: cost determined by hospital
-prospective: cost determined by 3rd party aka insurance company
-retrospective: hospital submits bill after services to recover reasonable costs regardless
of length of stay
-prospective: hospital is reimbursed by insurance company based on predetermined prices. These prices are based on diagnostic related groups, standard length of stay, and the medical procedure(s) being performed
under retrospective payment there is little incentive to control costs and more incentive to provide more services
under retrospective, hospital charges per diem (routine) or room rate plus ancillary services (diagnostic) |
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Term
Social Security Act of 1935:
what is it in a nutshell?
what is SSDI?
what is SSI? |
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Definition
-government insurance for Retired works over 65 with a continuing income
-passed after great depression
-SSDI (Social Security Disability Insurance) - pays benefits to people with disabilities as long they have been have been in the work force for a certain amount of time and paid social security takes
-SSI (Supplemental Security Income) - pays benefits based on financial need. Services people with who are blind or have a disability. They must have limited income and resources, meet the living arrangement requirements. |
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Term
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Definition
Serves people over 65 regardless of income
serves younger people with certain disabilities
serves people with end-stage renal disease |
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Term
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Definition
| (Social Security Disability Insurance) - pays benefits to people with disabilities as long they have been have been in the work force for a certain amount of time and paid social security takes |
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Term
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Definition
| (Supplemental Security Income) - pays benefits based on financial need. Services people with who are blind or have a disability. They must have limited income and resources, meet the living arrangement requirements. |
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Term
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Definition
Tax Equity & Fiscal Responsibility Act
limits on increase in operating costs based on previous year
limits on limits on ancillary service costs |
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Term
1983 DRGs
how were payments made?
beginning of...
how much reimbursement? |
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Definition
Diagnostic Related Groups
looked at inpatient hospital services & made payments by diagnosis
marked the beginning of prospective payment and cost containment in healthcare
will only be reimbursed a capped total on diagnostic treatments - no more individual reimbursements for individual treatments |
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Term
Medicare part A
what 4 expenses does it cover?
how is it paid for?
how much of hospital costs does it cover?
is it free? |
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Definition
Medicare part A - hospital insurance
-hospital care
-skilled nursing facilities
-hospice
-some home health care
-paid for by medicare tax
-covers 80% of hospital costs
it is NOT free - ~$90/month deducted from seniors' social security |
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Term
Medicare Part B
what 4 expenses does it cover?
is it free? |
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Definition
Medicare part B - Medical insurance
-doctors
-outpatient hospital care
-other special medical services (PT,OT,ST, etc.)
-some home health services
-monthly premium |
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Term
| what are ancillary services? |
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Definition
| services that are reasonable and necessary for diagnosis and treatment of a patient's condition |
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Term
| The ACA allows children to stay on their parents health plans until what age? |
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Definition
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Term
| Under the ACA, what happens to hospitals if they do not provide effective care? |
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Definition
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Term
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Definition
| Medicare Part C: Medicare Advantage |
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Term
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Definition
| Medicare Part D: Prescription Drug Coverage |
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