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Health Insurance C3

Health Insurance Chapter 3

____________ defines employer contributions and ask employees to be more responsible for healthcare decisions and cost sharing. CDHP (Consumer-directed health plans)
Managed care is being challenged by the growth of ____________. CDHP (Consumer-directed health plans)
___________ reimburse providers for individual healthcare services rendered. Fee for Service Plans
Managed care is financed accroding to a method called _______________. Capitation
__________ is responsible for supervising and coordinating healthcare services for enrollees and approves referrals to specialists and inpatient hospital admissions. Primary Care Provider
_____________ revies appropriateness and neccessity of care provided to patients prior to administration of care. Prospective Review
____________ revies the appropriateness and necessity of care provided to patients after the administration of care. Retrospective Review
__________ is a review for medical necessity of inpatient care prior to the patient's admission. Preadmission Certification
_____________ is a review for medical necessity of tests and procedures ordered during an inpatient hospitialization. Concurrent Review
_________ involves arranging appropriate healthcare services for the discharged patient. Discharge Planning
A second physician is asked to evaluate the necessity of surgery and recommend the most economical, appropriate facility in which to perform the surgery. Second Surgical Opinion
_________ include payments made directly or indirectly to healthcare providers to encourage them to reduce or limit services as to save money for the managed care plan. Physician Incentives
EPO Exclusive provider organization
IDS Integrated delivery system
HMO Healthcare maintenance organization
POS Point-of-service plan
PPO Preferred provider organization
_______ is a voluntary process that a healthcare facility or organization undergoes to to demonstrate that it has met the standards beyond those required by law. Accreditation
NCQA National Committee for Quality Assurance
A tax exempt account offered by employers which indiviuals use to pay healthcare bills. Inexpensive high deductible health plan and a health savings account is opened up to pay for current or future medical bills. HSA (Health Savings Account)
_________ is a review that grants prior approval for reimbursement of a healthcare service. Preauthorization
Effects of managed care on a physician's practice. Seperate bookkeeping for each capitated plan to ensure finacial viability of the contract.
Created by: tlindrose