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CHAPTER 2

DEFINITIONS

TermDefinition
BALANCED BUDGET ACT OF 1997 ADDRESSES HEALTHCARE FRAUD AND ABUSE ISSUES
CHAMPUS REFORM INITIATIVE RESULTED INA NEW PROGRAM, TRICARE, WHICHINCLUDES OPTIONS SUCH AS TRICARE PRIME, TRICARE EXTRA, AND TRICARE STANDARD
CLINICAL LABORATORY IMPROVEMENT ACT LEGISLATION ESTABLISHED QUALITY STANDARDS FOR ALL LABORATORY TESTING TO ENSURE THE ACCURACY, RELIABILITY, AND TIMELINESS OF PATIENT TEST RESULTS REGARDLESS OF WHERE THE TEST WAS PERFORMED
CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT OF 1985 (COBRA) ALLOWS THE EMPLOYEES TO CONTINUE HEALTHCARE COERAGE BEYOND THE BENEFIT TERMINATION DATE
EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 MANDATED REPORTING AND DISCLOSURE REQUIREMENTS FOR GROUP LIFE AND HEALTH PLANS
FEDERAL EMPLOYEES COMPESATION ACT PROVIDES CIVILLIAN EMPLOYEES OF FEDERAL GOV WITH MEDICAL CARE, SURVIVORS' BENEFITS, AND COMPENSATION FOR LOST WAGES
FEDERAL EMPLOYERS LIABILITY ACT LEGISLATION THAT PROTECTS AND COMPENSATES RAILROAD WORKERS WO ARE INJURED ON THE JOB
FINANCIAL SERVICES MODERNIZATION ACT OR GRAMM-LEACH-BLILEY ACT PROHIBITS SHARING OF MEDICAL INFORMATION AMONG HEALTH INSURERS AND OTHER FINANCIAL INSTITIUTIONS FOR USE IN MAKING CREDIT DECISIONS
HILL-BURTON ACT PROVIDED FEDERAL GRANTS FOR MODERNIZING HOSPITALS THAT HAD BECOME OBSOLETE BECAUSE OF LACK OF CAPITAL INVESTMENT DURING THE GREAT DEPRESSION AND WWII IN RETURN FOR FEDERAL FUNDS, FACILITIES WERE REQUIRED TO PROVIDE SERVICES FREE OR AT REDUCED RATES TO PAT
MEDICARE, MEDICAID, AND SCHIP BENEFITS IMPROVEMENT AND PROTECTION ACT OF 2000 REQUIRES IMPLEMENTATION OF A 400 BILLION PRESCRIPTION DRUG BENEFIT, IMPROVED MEDICARE ADVANTAGE BENEFITS, FASTER MEDICARE APPEALS DECISIONS, AND MORE
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT AND MODERATION ACT ADDS NEW PRESCRIPTION DRUG AND PREVENTIVE BENEFITS, PROVIDES EXTRA ASSISTANCE TO PEOPLE WITH LOW INCOMES, AND CALLS FOR IMPLEMENTATION OF A MEDICARE CONTRACTIONG REFORM INIATIVE TO IMPROVE AND MODERNIZE THE MEDICARE FEE FOR SERVICE SYSTEM
OMNIBUS BUDGET RECONCILITATION ACT OF 1981 EXPANDED THE MEDICARE AND MEDICAID PROGRAMS
PATIENT PROTECTION AND AFFORDABLE CARE ACT FOCUSES ON PRIVATE HEALTH INSURANCE REFORM TO PROVIDE BETTER COVERAGE FOR INDIVIDUALS WITH PRE EXISTING CONDITIONS, IMPROVE PRESCRIPTION DRUG COVERAGE UNDER MEDICARE
TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1982 CREATED MEDICARE RISK PROGRAMS, WHICH ALLOWED FEDERALLY QUALIFIED HMOS AND COMPETITIVE MEDICAL PLANS THAT MET SPECIFIED MEDICARE REQUIRMENTS TO PROVIDE MEDICARE COVERED SERVICES UNDER A RISK CONTRACT
GROUP HEALTH INSURANCE COVERAGE SUBSIDIZED BY EMPLOYERS AND OTHER ORGANIZATIONS
INDIVIDUAL HEALTH INSURANCE PRIVATE HEALTH INSURANCE POLICY PURCHASED BY INDIVIDUALS OR FAMILIES WHO DO NOT HAVE ACCESS TO GROUP HEALTH ISURANCE COVERAGE
PUBLIC HEALTH INSURANCE FEDERAL AND STATE GOVERNMENT HEALTH PROGRAMS AVAILABLE TO ELIGIBLE INDIVIDUALS
SINGLE PAYER PLAN CETRALIZED HEALTHCARE SYSTEM ADOPTED BY SOME WESTERN NATIONS AD FUNDED BY TAXES, GOVERNMENT PAYS FOR EACH RESIDENTS HEALTH CARE
SOCIALIZED MEDICINE TYPE OF SIGLE PAYER SYSTEM I WHICH THE GOVERNMENT OWNS AND OPERATES HEALTHCARE FAILITIES AND PROVIDERS RECEIVE SALARIES, VA PROGRAM IS A FORM OF SOCIEALIZED MEDICINE
UNIVERSAL HEALTH INSURANCE GOAL OF PROVIDING EVERY INDIVIDUAL WITH ACCESS TO HEALTH COVERAGE, REGARDLESS OF THE SYSTEM IMPLEMENTED TO ACHIEVE THAT GOAL
BLUE SHIELD 1939 FOUNDED IN CALIFORNIA
ICD 1948 WORLD HEALTH ORGANIZATION WHO DEVELOPED THE INTERNATIONAL CLASSIFICATION OF DISEASES
MAGOR MEDICAL INSURANCE 1950 INSURANCE COMPANIES BEGAN OFFERING, PROVIDES COVERAGE FOR CATASTROPHIC OR PROLONGED ILLNESSES AND INJURIES
DEDUCTIBLE AMOUNT FOR WHICH THE PATIENT IS FINANCIALLY RESPONSIBLE BEFORE AN INSURANCE POLICY PROVIDES PAYMENT
LIFETIME MAXIMUM AMOUNT MAMIMUM BENEFITS PAYABLE TO A HEALTH PLAN PARTICIPANT
MEDICARE 1966 PROVIDES HEALTHCARE SERVICES TO AMERICANS OVER THE AGE OF 65
MEDICAID 1966 IS A COST SHARING PROGRAM BETWEEN THE FEDERAL AND STATE GOVERNMENTS TO PROVIDE HEALTHCARE SERVICES TO LOW INCOME AMERICANS
CPT CURRENT PROCEDURAL TERMINOLOGY WAS DEVELOPED BY THE AMERCAN MEDICAL ASSOCIATION IN 1966
HMOs THE HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ACT OF 1973 AUTHORIZED FEDERAL GRANTS AND LOANS TO PRIVATE ORGANIZATIONS THATWISHED TO DEVELOP HEALT MAINTENANCE ORGANIZATIONS (HMOS) WHICH ARE RESPONSIBLE FOR PROVIDING HEALTHCARE SERVICES TO SUBSCRIBERS IN
HCFA HEALTH CARE FINANCING ADMINISTRATION WAS FORMED WITHIN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES NOW CALLED THE CENTERS FOR MEDICARE AND MEDICAID SERVICES OR CMS
RBRVS RESOURCE BASED RELATIVE VALUE SCALE SYSTEM REIMBURSES PHYSICIANS PRACTICE EXPENSE BASED ON RELATIVE VALUES FOR THREE COMPONENTS OF EACH PHYSICIAN'S SERVICE, PHYSICIAN WORK, PRACTICE EXPENSE, AND MALPRACTICE INSURANCE EXPENSE
NCCI NATIONAL CORRECT CODING INITIATIVE CREATED TO PROMOTE NATIONAL CORRECT CODING METHODOLOGIES AND TO ELIMINATE IMPROPER CODING
HIPAA HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT MANDATES REGULATIONS THAT GOVERN PRIVACY, SECURITY,AND ELECTRONIC TRANSACTIO STANDDARDS FOR HEALTHCARE INFORMATION, PRIMARY INTENT IS TO PROVIDE BETTER ACCESS TO HEALTH INSURANCE, LIMIT FRAUD AND ABUSE, AND REDUCE ADMINISTRATIVE COSTS
SNF PPS SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM IS IMPLEMENTED TO COVER ALL COSTS RELATED TO SERVICES FURNISHED TO MEDICARE PART A BENEFICIARIES IT GENERATES PER DIEM PAYMENTS FOR EACH ADMISSION; THESE PAYMENTSARE CASE MIX ADJUSTED USING RESOURCE UTILIZATION GROUPS WHICH IS BASED ON DATA COLLECTED FROM
HH PPS HOME HEALTH PROSPECTIVE PAYMENT SYSTEM REIMBURSES HOME HEALTH AGENCIES AT A PREDETERMINEDRATE FOR HEALTHCARE SERVICES PROVIDED TO PATIENTS IT USES TH OUTCOMES AND ASSESSMENT INFORMATION SET (OASIS)
OPPS OUTPATIENT PROSPECTIVE PAYMENT SYSTEM USES AMBULATORY PAYMENT CLASSIFICATIONS TO CALCULATE REIMBURSEMENT, IS IMPLEMENTED FOR BILLING OF HOSPITAL BASED MEDICARE OUTPATIENT CLAIMS
ARRA AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 AUTHORIZED AN EXPENDITURE OF 1.5 BILLION FOR GRANTS FOR CONSTRUCTION, RENOVATIO, AND EQUIPMENT, AND FOR THE ACQUISTION OF HEALTH INFORMATION TECHNOLOGY SYSTEMS
PATIENT RECORD DOCUMENTS HEALTHCARE SERVICES PROVIDED TO A PATIET AND INCLUDES PATIENT DEMOGRAPHIC DATA,DIAGNOSIS, AND JUSTIFY TREATMENT PROVIDED, AND THE RESULTS OF TREATMENT
CONTINUITY OF CARE DOCUMENTING PATIENT CARE SERVICES SO THAT OTHERS WHO TREAT THE PATIENT HAVE A SOURCE OF INFORMATION TO ASSIST WITH ADDITIONAL CARE AND TREATMENT
PROSPECTIVE PAYMENT SYSTEM ISSUES A PREDETERMINED PAYMENT FOR INPAIENT SERVICES
Created by: mmoore8209