Review of Ch 3, 13, 14 terms
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Identifies the patient to the insurance company | ID number
🗑
|
||||
| Identifies the patient's employer group health plan | Group number
🗑
|
||||
| A specific name assigned by the insurance company designating a specific plan for that type of insurance. | plan type
🗑
|
||||
| Traditional insurance where reimbursement is made at 80 percent of the allowed amount and the patient pays the remaining 20 percent. | Indemnity
🗑
|
||||
| Payment is made for each service provided. | Fee for Service
🗑
|
||||
| Special clauses giving additional coverage over and above the standard contract. | Riders
🗑
|
||||
| Originally provided coverage for hospital bills | Blue Cross
🗑
|
||||
| Originally provided coverage for physician bills. | Blue Shield
🗑
|
||||
| Indemnity plan for Blue Cross/Blue Shield | ClassicBlue
🗑
|
||||
| Managed Care plan for Blue Cross/Blue Shield | PPOBlue
🗑
|
||||
| Medicare Advantage plan for Blue Cross/Blue Shield | SecurityBlue
🗑
|
||||
| Medicare Part D plan for Blue Cross/Blue Shield | BlueRx
🗑
|
||||
| Medicare Supplemental Plan for Blue Cross/Blue Shield | MedigapBlue
🗑
|
||||
| A Federally funded program administered by the Centers for Medicare and Medicaid - for citizens 65 and over | Medicare
🗑
|
||||
| Pays for inpatient hospital, skilled nursing facilities, hospice care and home health | Medicare Part A
🗑
|
||||
| Pays for doctor services, outpatient hospital, durable medical equipment | Medicare Part B
🗑
|
||||
| The 2014 deductible for Medicare part B | $147
🗑
|
||||
| Managed care plans and fee-for-service plans that are an alternative to original Medicare | Medicare Part C
🗑
|
||||
| Private prescription drug plans that helps pay for prescriptions under Medicare | Medicare Part D
🗑
|
||||
| Supplemental insurance that covers costs not reimbursed by original Medicare plan | Medigap
🗑
|
||||
| Provides payment for health care services for eligible low income individuals | Medicaid
🗑
|
||||
| Health insurance provided to active and retired military personnel and their dependents | Tricare
🗑
|
||||
| Tricare members receive their care at this facility by a Tricare-contracted civilian provider | Military Treatment Facility
🗑
|
||||
| For a premium, cardholders are eligible for a discount on medical services--it is not health insurance. | Medical Discount Card
🗑
|
||||
| Includes financing, management, and delivery of health care services | Managed Care Plan
🗑
|
||||
| Can be a health plan, hospital, physician group or health system | Managed Care Organization
🗑
|
||||
| Prepaid health care; there is a pre-established payment for all health services | Managed Care
🗑
|
||||
| Providers are prepaid monthly for members enrolled in a managed care plan; regardless of whether the patient is seen or not. | Capitation
🗑
|
||||
| Physicians that participate in a managed care plan; they supervise health care for enrollees | Primary Care Physician
🗑
|
||||
| Another term for a Primary Care Physician | Gatekeeper
🗑
|
||||
| Managed Care Plans are required to meet minimum performance standards | Quality Assurance
🗑
|
||||
| Legislation that created standards to assess managed care plans | HEDIS
🗑
|
||||
| Assesses managed care plans; creates report cards on each plan | NCQA
🗑
|
||||
| Assesses health care facilities | JCAHO
🗑
|
||||
| Controls costs by reviewing the appropriateness and necessity of care prior to admission or administration of care | Utilization review
🗑
|
||||
| Reviews the medical necessity of a procedure or service before it is done. | Preauthorization
🗑
|
||||
| It reviews the medical necessity of any tests and procedures during hospitalization | Concurrent review
🗑
|
||||
| Reviews the most cost-effective care after hospitalization | Discharge Planning
🗑
|
||||
| Develops patient care plans for complicated or chronic diagnosed cases | Case Management
🗑
|
||||
| Prevented providers from discussing all treatment options with the patient; now largely prohibited | Gag clauses
🗑
|
||||
| Offered to physicians to encourage them to keep costs down | Physician incentives
🗑
|
||||
| Provides services to enrolled members on a pre-paid basis | Health Maintenance Organization
🗑
|
||||
| Medical Care sought from participating providers within a managed care plan | In-network
🗑
|
||||
| Medical care sought from nonparticipating providers | Out-of-network
🗑
|
||||
| Group of physicians, hospitals, and providers that offer price discounts to insurance companies in exchange for more members | Preferred Provider Organization
🗑
|
||||
| Provides benefits if they receive services from network providers only | Exclusive Provider Organization
🗑
|
||||
| Patients have the freedom to use HMO providers or to self-refer out to non-HMO providers for a higher fee | Point of Service Plan
🗑
|
||||
| Provides subscribers or employees a choice of HMO, PPO, or traditional health plans | Triple Option Plan
🗑
|
||||
| another name for Triple Option Plan | Cafeteria Plan
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Kirkster
Popular Medical sets