Term
|
Definition
| Ability to find coverage that is appropriate and individually affordable |
|
|
Term
|
Definition
| Based on survey (inspection or review). JCAHO is the largest accreditating body. Hospitals must have accreditation in order to receive reimbursement from most insurers |
|
|
Term
Balanced budget act of 1997
|
|
Definition
A summary of the Balanced Budget Act of 1997 by the Congressional Budget Office reported that the law projected $112 billion in savings from slowing projected spending increases in Medicare. In addition, the act called for $7 billion in savings from changes to Medicaid, a federal health care program for the poor; $15 billion in savings from other cuts in government spending; and $26 billion in new revenues.
The Balanced Budget Act of 1997 | eHow.com http://www.ehow.com/info_8040528_balanced-budget-act-1997.html#ixzz2EktshAZ9 |
|
|
Term
|
Definition
| fixed amount paid to the provider per member |
|
|
Term
|
Definition
Center for Medicare and Medicaid
The department responsible for the administration of these programs, however, ultimare power for Medicaid is given to the individual states |
|
|
Term
|
Definition
| A process that is generally individual, based on testing to demonstrate competency at a higher level |
|
|
Term
|
Definition
| Civilian Health and Medical Program of the Uniformed Services - A federally funded program that provides members with medical care |
|
|
Term
|
Definition
| Monitoring inpatient care while the patient is still recieving it - decisions are made by using best practice criteria |
|
|
Term
|
Definition
| Fixed amount paid at the time of service |
|
|
Term
|
Definition
| Amount you are responsible for - when the deductible is paid fully by the member, insurance pays |
|
|
Term
|
Definition
| Diagnostic Related Grouping - similar diagnosis that pay a single fee - for example, if a patient is in the hospital for surgery, all similar surgeries will pay the same amount |
|
|
Term
|
Definition
| Being paid for the actual services rendered, not a fixed reimbursement rate |
|
|
Term
|
Definition
'Employee Retirement Income Security Act - ERISA'
The Employee Retirement Income Security Act of 1974 (ERISA) protects the retirement assets of Americans by implementing rules that qualified plans must follow to ensure that plan fiduciaries do not misuse plan assets.
http://www.investopedia.com/terms/e/erisa.asp#ixzz2ElFoV7Yg |
|
|
Term
Employer sponsored health insurance
|
|
Definition
| Insurance that one gets through their employer - employer generally pays a portion or all of the insurance |
|
|
Term
|
Definition
| $23,050 for a family of 4. Defined as a lack of the usual or socially acceptable amount of money or material possessions |
|
|
Term
|
Definition
| A rate paid for services that is a single amount, i.e. all dermatology visits are paid at $125/visit, or all appendectomies are paid the same regardless of the amount of time spent in the OR |
|
|
Term
|
Definition
| Usually the Primary Care Physician (PCP) through whom the patient's care flows - gatekeeper determines who the patient will see for certain other problems, i.e. dermatology, psychiatry |
|
|
Term
|
Definition
Health Maintenance Organization
Generally has a small pool of physicians who are paid at a per member/month rate - patient may only see specialists by referral from their PCP |
|
|
Term
|
Definition
| Health insurance portability and accountability act - among other things, protects patient privacy |
|
|
Term
|
Definition
| The process of monitoring care rendered for appropriateness of setting, utilization of services, and quality of care |
|
|
Term
Managed care organization
|
|
Definition
| Companies (can be an insurance company) that provide oversight of care |
|
|
Term
|
Definition
| Federal regulations are the minimum benefts allowed - states may add to the benefit and Medicaid is the responsibility of the state |
|
|
Term
|
Definition
| Federally funded and managed health care for the elderly and some conditions such as End Stage Renal Disease |
|
|
Term
|
Definition
| Prospective Payment System - providers are paid a predetermined sum for care given |
|
|
Term
|
Definition
| Preferred Provider Organization - contracted providers whom enrollees can choose from - if the member does not chose one of the PPO physicians, they are said to be going "out of network" and will pay a higher fee for their care |
|
|
Term
|
Definition
The maximum amount you have to pay for care:
For instance - first you are responsible for deductible
Second you probably have to pay a copay
Once you have reached a certain dollar amount (which includes the deductible and copay) you may reach the out of pocket maximum, which then qualifies you to not have to pay anymore for that year. |
|
|
Term
|
Definition
| Pay for performance - pay based on outcomes |
|
|
Term
|
Definition
| the act of reviewing the necessity of care before it is rendered |
|
|
Term
|
Definition
| A condition the member had before they begin a new insurance - may prevent care related to that illness from being paid for a given period. |
|
|
Term
|
Definition
| monthly, quarterly, etc. paid to the insurance company in order to have insurance |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Not a state or federally administered insurance program |
|
|
Term
|
Definition
| measured by observation and data analysis - the appropriatenss of the care being given. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| required for reimbursement - facilities are licensed by a number of licensing agencies - most notably Medicare - accomplished via a provider inspection |
|
|
Term
|
Definition
| Resource based relative value scale - a reimbursement methodology based on the relative value and the time/resources required to care for a patient |
|
|
Term
|
Definition
| review of care after the care is given - chart review |
|
|
Term
|
Definition
| special programs created by state legislatures to provide a safety net for the "medically uninsurable" population |
|
|
Term
|
Definition
| Law which prevents proprietary interest in any referrals |
|
|
Term
|
Definition
| State Children's Health Insurance Plan program administered by the department of health and human services that provides matching funds to states for provide care to families with children. The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for medicaid |
|
|
Term
|
Definition
| Insurance that is "extra" but generally covers those things not covered by traditional insurance |
|
|
Term
|
Definition
Regina Benjamin, MD
Protect and advance the health of the Nation through educating the public, advocating for effective disease prevention and health promotion programs and activities, and, providing a highly recognized symbol of national commitment to protecting and improving the public's health, |
|
|
Term
Secretary of health and human services
|
|
Definition
Kathleen Sebelius
The duties of the secretary revolve around human conditions and concerns in the US. This includes advising the President on matters of health, welfare and income security programs. It strives to administer the department of Health and Human Services to carry out approved programs and make the public aware of the objectives of the department. |
|
|
Term
|
Definition
Temporary Assistance for Needy Families
Temporary insurance provided for those with limited resources. |
|
|
Term
|
Definition
Independent Practice Association, or IPA, is an organization comprised of physicians who maintain their independent practices and also join together as an association.
Definition of IPA Managed Health Care Insurance | eHow.com http://www.ehow.com/about_6631430_definition-managed-health-care-insurance.html#ixzz2ElQeYJi4 |
|
|
Term
|
Definition
| health care program of theUS department of Defense Military Insurance Systems Tricare provides civilian health benefits for military personell, military retirees and their dependents |
|
|
Term
|
Definition
| Those without insurance due to finances or personal choice |
|
|
Term
|
Definition
| Everyone is entitled to healthcare - similar to the Obama plan (the affordable health act) - Canada and England as well as other countries provide universal access |
|
|
