1st part of the healthcare industry diagram: Government oversees all aspects of healthcare. - answer-There is the US department of health and human services, and there are the individual state departments of health. The secretary of Health and Human Services reports to the president. They oversee a...
,HCA 285 Exam #1
1st part of the healthcare industry diagram: Government oversees all aspects of healthcare. -
answer-There is the US department of health and human services, and there are the individual
state departments of health. The secretary of Health and Human Services reports to the
president. They oversee all of healthcare.
2nd part of the healthcare industry diagram: patients (controlled by payers) - answer-This is in
order of how good their payment method is from best to worst:
Employer insured
individual market insured
CMS medicare
CMS/State medicaid
uninsured (when answering questions about this make sure to list the patients because it is
patients categorized by the payers.)
3rd part of the healthcare industry diagram: Healthcare providers - answer-There is Acute care,
post acute care, outpatient care, long-term care, and home health
4th part of the healthcare industry diagram: Peripheral entities - answer-Insurance industry, 3rd
party organizations and suppliers and manufacturers.
Accreditation applies to both physicians and organizations - answer-false
acute care - answer-treating people who wish to return to as much as possible a normal daily
function. Organizations: hospitals, ambulatory surgery centers, urgent care clinics and/or retail
health clinics. Medicare pays for one hundred days of this type of care and post this type of care
rehabilitation for each incident if required.
Advocacy organizations - answer-legal and/or political representation. Organizations that lobby
and what not. There are ones that help like facilities.
Advocacy organizations within the healthcare industry - answer-The American Medical
Association (physician advocacy)
The American Hospital Association Not-For-Profit (advocacy for voluntary hospitals)
The Federation of American Hospitals For-Profit (advocacy for proprietary hospitals)
Anti-Kickback Statute (AKS) / Legislation of 1972 - answer-Prohibits asking for or receiving
anything of value to induce or reward referrals of federal healthcare program business (namely
CMS and may include health services, drugs, and supplies).
Are the governing board ever employed by the hospital? - answer-No
are there more for-profit or not-for-profit hospitals? - answer-48% not-for-profit hospitals
(private), 21% for-profit (investor owned) 19% government
asset - answer-an item that either possess or creates an economic benefit for the organization
At a basic level, all integrated healthcare networks are multi-hospital systems. However..... -
answer-not all multi-hospital systems are integrated healthcare networks
, Balance Sheet - answer-a statement of the assets, liabilities, equity, and capital of a business or
other organization at a particular point in time, detailing the balance of income and expenditure
over the preceding period.
Capital - answer-an expense (purchase) that is over $3,000 and will be used on more than one
patient
Captial - answer-money for investment
Civil Law - answer-the system of law concerned with private relations between members of a
community rather than criminal, military, or religious affairs
Co-insurance - answer-After the deductible is paid the individual will begin paying a percentage
of their medical costs and the insurance company will pay the rest of the percentage.
Co-pay - answer-a fixed amount, such as 25$, that a member must pay out-of-pocket for a
medical service or prescription.
contractual allowance - answer-The discounts offered to insurance companies, and the
difference between what is charged and medicare's or medicaid's fixed fee schedule that must
be deducted from Gross Revenue
Criminal Law - answer-a system of law concerned with the punishment of those who commit
crimes considered to be harmful to society as a whole
daily living - answer-It is fundamental skills required to independently care for oneself, such as
eating, bathing, and mobility. ADLs stands for activities of daily living.
deductible - answer-a set limit we must pay as patients before our co-insurance kicks.
Deductible - answer-the amount of out-of-pocket costs that must be paid by the member at the
beginning of the year before any portion is paid by the health plan.
Deductions from Gross Revenue - answer-Contractual Allowances
Bad Debt
Charity Care
defensive medicine - answer-Ordering more tests and procedures than are necessary in order
to protect oneself from a lawsuit. In other words medicine practiced in such a way as to reduce
the risk of malpractice litigation, typically by the use of excessive diagnostic testing. These
unnecessary measures lead to rising healthcare costs and make healthcare less affordable.
Define board certification and describe board certification how it applies physicians - answer-a
physician goes to ABMS and takes a test to get the certification. It is a voluntary but helpful
because it means you are a really great physician if you get it.
Depreciation - answer-An accounting method of allocating the cost of a capital item over the
course of its useful life (recorded in income statement)
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