Term
| whos the biggest consumer of of health care and pays for medicare and medicaid? |
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Definition
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Term
| explain utilization committees |
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Definition
| they are medicare driven, they review admissions based on diagnostics and they identify and eliminate overuse of services |
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Term
what is the PPS (perspective payment system)?
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Definition
| it eliminates cost based reimbursement |
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Term
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Definition
| diagnostic groups and capitation where developed |
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Term
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Definition
| a fixed amount per patient of health care plan. it was developed for specific surgeries treatments |
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Term
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Definition
| administrative control over primary health care services for set population |
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Term
| What are RUGs( research utilization groups)/ |
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Definition
| they use DRGs in rehabilitation/ long - term care settings |
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Term
| Under the managed care system dos the health care system assume financial risk and do they provide care |
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Definition
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Term
| what is the focus of a managed care organization |
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Definition
| the health maintenance by primary physician |
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Term
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Definition
| it is a federal program that takes a SS deduction for any one over 65. There are 4 parts to medicare |
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Term
| what is part a of the medicare plan? |
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Definition
| it is basic protection (meical surgical and psychiatric costs based on DRG |
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Term
| what is part b of medicare |
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Definition
| it is voluntary medical insurance (physician and output services) |
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Term
| What is part c of the medicare program? |
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Definition
| it is a managed care choice with three service plans |
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Term
| what is part d of the medicare plan? |
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Definition
| it is a prescription drug plan |
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Term
| who benefits from medicaid? |
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Definition
| low income families, health assistance, low-income long term care patients. |
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Term
| what is a private insurance? |
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Definition
| it is the traditional fee- for services |
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Term
| what does long term care insurance come wiht? |
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Definition
| skilled nursing, intermediate, custodial care and home care |
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Term
| what is a preventive and primary prevention? |
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Definition
| it is preventing illness along with education |
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Term
| what is a primary prevention |
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Definition
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Term
| what does secondary and tetiary care focus on? |
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Definition
| they focus on diagnosis and treatment of disease |
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Term
| what are the settings for secondary and tertiary care? |
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Definition
| hospitals, subacute care and rural hospitals |
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