Match the health care definition with the term (Points : 13) Potential Matches:1 : Cost sharing 2 : Managed Care Organizations (MCO) 3 : Fee-for-Service (FFS) 4 : Diagnosis Related Group (DRG) 5 : Cultural Competency 6 : Capitation 7 : Prospective Payment System (PPS) 8 : Pay-for-performance 9 : Centers for Disease Control (CDC) 10 : Public Health 11 : Explanation of Benefits (EOB) 12 : Nostrum 13 : Gatekeeping Answer [removed] : Managed care’s way of classifying patients by diagnosis, average length of hospital stay, and therapy received [removed] : Summarizes what the insurance company paid the provider, how much the patient owes, and provides an up-to-date status of the patient’s annual deductible and out of pocket expenses [removed] : Employees become part of their employer’s group insurance plan and the employer subsidizes the monthly premiums [removed] : Emphasized environmental sanitation to stop the spread of epidemic diseases [removed] : Each individual service or treatment is paid and billed separately [removed] : A derogatory term for a medicine, especially an ineffective one, prepared by an unqualified person [removed] : Involves bundled payments when physicians are paid for a series of treatments that are not billable individually [removed] : Preventing unnecessary specialized care [removed] : Global mission of health protection, prevention, and preparedness [removed] : Practice of recognizing that different groups have unique health experiences and needs [removed] : Enter into contracts with hospitals and healthcare professionals to provide healthcare to the beneficiaries in exchange for a negotiated rate per patient [removed] : Amount of payment is determined prospectively, before the service is rendered [removed] : Reimbursement models aimed at improving the quality, efficiency, and overall value of health careMatch the real word example with the term (Points : 13) Potential Matches:1 : Nostrum 2 : Fee-for-Service 3 : Public Health 4 : Capitation 5 : Diagnosis Related Group (DRG) 6 : Gatekeeping 7 : Prospective Payment System (PPS) 8 : Pay-for-Performance 9 : Cost Sharing 10 : Explanation of Benefits (EOB) 11 : Managed Care Organization (MCO) 12 : Cultural Competency 13 : Centers for Disease Control (CDC) Answer [removed] : Hospitals, skilled nursing facilities and home health agencies are reimbursed on an “episode of care basis” [removed] : Dr. Thomas exams a patient named Jan. Jan’s health insurance provider is Blue Cross Blue Shield. Services provided included a Chest X-ray, yearly physical, and removal of a mole. Dr. Thomas receives reimbursement for each service rendered [removed] : Dr. Thomas exams a patient named Jen. Jen’s health insurance provider is HealthPlus of Michigan. Services provided included a yearly physical, removing a mole and ordering of labs and chest x-ray. Dr. Thomas receives reimbursement based on a contracted discounted rate [removed] : Jan receives a report from the health plan listing the blood work, chest x-ray and physical she received at her primary care physician’s office [removed] : Mr. Jenkins owns a hardware in 1880s and starts to treat patients [removed] : Dr. Thomas receives the same amount per patient per month whether the patient is receiving services or not [removed] : Jan goes to the primary care physician in order to receive a referral to a specialist [removed] : Jan is in severe pain evidenced by Nursing assessment of raised blood pressure, facial grimacing, and holding abdomen. However, she does not complain of pain [removed] : Dr. Thomas reports to this entity that she has diagnosed a patient with Tuberculosis [removed] : Jan is employed by ACME Tile, receives health insurance as a benefit and contributes $100/month to the premium [removed] : Promotes a Youth advertising campaign to promote healthy eating and exercise [removed] : Patient presents to the ER with COPD and is admitted to the hospital. The hospital is reimbursed based on the COPD Diagnosis [removed] : Dr. Thomas educates and advises patients on quitting smoking, exercise, and health eating. Dr. Thomas receives reimbursement for meeting quality measures
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