Full Answer
What is a provider in health insurance?
A provider is classified as a/an: a. beneficiary that provides information for insurance coverage. b. coder who provides medical record data. c. biller who submits claims to insurance carriers. d. individual or group of individuals that provide a health care service.
What is an organization that provides care to terminally ill patients called?
An organization that provides pain relief and supportive care to terminally ill patients is called a/an: a. inpatient hospital. b. hospice. c. nursing home. d. ambulatory surgery center. b. hospice. Businesses that provide support services to individual physicians are called: a. management service organizations. b. physician hospital organizations.
What is covered by Medicare Part A?
Covered by Medicare Part A is care received at home as part-time skilled nursing care, speech therapy, physical or occupational therapy, or part-time services of home health aides. Can include housework or other daily chores the the patient can no longer perform.
What is the role of the provider in managed care?
In return, the provider agrees to deliver the health services agreed upon to any person covered under the managed care plan. The payment provided has no relationship to the type of service per- formed or number of services the patient receives.
What is preferred provider organization?
Preferred provider organizations represent an organization of hospitals and physicians who, for a set fee, provide services to insurance company clients. These providers are listed as "preferred," and the insured may select from any number of hospitals and physicians without the restrictions involved with an HMO.
What is managed care plan?
Managed Care Plan. A managed care plan is a plan that involves financing, managing, and delivery of health care services. Typically, it involves a group of providers who share the financial risk of the plan or who have an incentive to deliver cost-effective, quality health care services.
What is a gap in Medicare?
Medigap Insurance. Medigap insurance is a health insurance plan that fills the "gaps" in Medicare plan coverage.
What is tricare for military?
TRICARE is a health care program available for members of the uniformed services , their families and survivors, and retired members and their families, or others registered in the Defense Enrollment Eligibility Reporting System (DEERS).
What is NCQA?
National Committee for Quality Assurance (NCQA) The National Committee for Quality Assurance (NCQA) began in 1990 with a simple mission—to improve the quality of health care. Although it's a private, nonprofit organization, NCQA's dedication to improving the quality of health care has made it an industry leader.
What is the Indian Health Service?
Indian Health Service (IHS) The goal of the Indian Health Service (IHS) is to "assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people.".
What is the CHIP program?
Children's Health Insurance Program (CHIP) Initiated by the Balanced Budget Act in 1997, CHIP is also known as Title XXI of the Social Security Act. CHIP provides federal funds to states to expand Medicaid eligibility to include a greater number of uninsured children. TRICARE.
What is a nurse manager?
You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care.
What is merger in home health?
A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization's changes are: a.
What is Medicare Part A?
Tap card to see definition 👆. hospitalization insurance, primarily financed from payroll taxes and is considered hospital insurance, employer and employee contribute to the Social Security (Medicare) fund, no premiums due if you or your spouse paid Medicare taxes for at least 10 years.
What is an ACO in healthcare?
Accountable Care Organizations (ACOs) groups of providers and hospitals who volunteer to give coordinated care to Medicare patients, goal is to ensure that patients, especially with chronic conditions, receive timely care while avoiding duplication of services and preventing medical errors.
What is optional Medicaid?
an optional Medicaid benefit, which focuses on community health services to Medicaid enrollees with disabilities, will enable consumers to receive care at home or at community health centers rather than going to a hospital or their facility
What is the program of all inclusive care for the elderly?
Program of All-Inclusive Care for the Elderly (PACE) a comprehensive healthcare delivery system funded by Medicare and Medicaid, focuses a comprehensive healthcare delivery system funded by Medicare and Medicaid, authorized by the Balanced Budget Act of 1997, philosophy by the Balanced Budget Act of 1997. Worker's Compensation.
What is the most common type of reimbursement?
Service Benefit Plan. most common type of reimbursement, method was developed and used primarily by managed care organizations, employer has a contract with a benefit plan and pays a premium for each of its employees, employees usually also pay a portion of the premium to the health plan.
Is Medicaid based on income?
(True/False) Medicaid is a program based on an individual's income. true.
Is Medicare Part A financed by payroll taxes?
Medicare Part A. hospitalization insurance, primarily financed from payroll taxes and is considered hospital insurance, employer and employee contribute to the Social Security (Medicare) fund, no premiums due if you or your spouse paid Medicare taxes for at least 10 years. Medicare Part B.