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MBC 132 - Words to Know (Ch 1-2)
Chapters 1-2
29
Medical
Professional
11/28/2010

Additional Medical Flashcards

 


 

Cards

Term
Beneficiary
Definition
person who benefits from health or life insurance
Term
Federal Register
Definition
official publication of all "residential Documents," "Rules and Regulations," and "Notices"; government-instituted national changes are published in the Federal Register
Term
Group Practice Model
Definition
an organization of physicians who contract with a Health Maintenance Organization to provide service to the enrollees of the HMO
Term
grouper
Definition
computer used to input the principal diagnosis and other critical information about a patient and then provide the correct DRG code
Term
Health Maintenance Organization Act
Definition
requires any company with at least 25 employees to provide an HMO alternative to regular group insurance.
Term
Individual Practice Association
Definition
an organization of physicians who provide services for a set fee; Health Maintenance Organizations often contract with the IPA for services to their enrollees
Term
Major Diagnostic Categories
Definition
the division of all principal diagnoses into 25 mutually exclusive principal diagnosis areas within the DRG system
Term
Managed Care Organization
Definition
a group that is responsible for the health care services offered to an enrolled group of persons
Term
Maximum Actual Allowable Charge
Definition
limitation on the total amount that can be charged by physicians who are not participants in Medicate
Term
Medical Volume Performance Standards
Definition
government's estimate of how much growth is appropriate for nationwide physician expenditures paid by the Part B Medicare program
Term
Medicare Economic Index
Definition
government mandated index that ties increases in the Medicare prevailing charges to economic indicators
Term
Medicare Fee Schedule
Definition
schedule that listed the allowable charges for Medicare services; was replaced by the Medicare reasonable charge payment system
Term
Medicare Risk HMO
Definition
a Medicare-funded alternative to the standard Medicare supplemental coverage
Term
National Provider Identifier
Definition
a 10-digit number assigned to a physician by Medicare
Term
Omnibus Budget Reconciliation Act of 1989
Definition
act that established new rules for Medicare reimbursement
Term
Part A
Definition
Medicare's Hospital Insurance; covers hospital/facility care
Term
Part B
Definition
Medicare's Supplemental Medical Insurance; covers physician services and durable medical equipment that are not paid for under Part A
Term
participating provider program
Definition
Medicare providers who have agreed in advance to accept assignment on all Medicare claims, now termed Quality Improvement Organizations (QIO)
Term
Peer Review Organization
Definition
groups established to review hospital admission and care
Term
Preferred Provider Organization
Definition
a group of providers who form a network and who have agreed to provide services to enrollees at a discounted rate
Term
primary care physician
Definition
physician who oversees a patient's care with a managed care organization
Term
prior approval
Definition
also known as a prior authorization, the payer's approval of care
Term
Professional Standards Review Organization
Definition
voluntary physicians' organization designed to monitor the necessity of hospital admissions, treatment costs, and medical records of hospitals
Term
Provider Identification Number
Definition
assigned to physicians by payers for use in claims submission
Term
Quality Improvement Organizations
Definition
consists of a national network of 53 entities that work with consumers, physicians, hospitals, and caregivers to refine care delivery systems
Term
Relative Value Unit
Definition
unit value that has been assigned for each service
Term
Resource-Based Relative Value Scale
Definition
scale designed to decrease Medicare expenditures, redistribute physician payment, and ensure quality health care at reasonable rates
Term
Staff Model
Definition
a Health Maintenance Organization that directly employs the physicians who provide services to enrollees
Term
Tax Equity and Fiscal Responsibility Act
Definition
act that contains language to reward cost-conscious healthcare providers
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