Unit 4: Healthcare Systems

Question 1

Deductibles

Answer 1

A specified amount of money that the insured must pay before an insurance company will pay a claim.

Question 2

What does HIPPA security rule do?

Answer 2

Establishes standards for the protection health information that is held or transferred in electronic form.

Question 3

Which part of Medicare helps pay for the services of physicians, outpatient hospital services, and medical equipment and supplies?

Answer 3

Part B

Question 4

WHO (World Health Organization) is sponsored by who?

Answer 4

United Nations

Question 5

Patients are able to perform many of their own activities of daily living (ADL) may utilize which of the following facilities?

Answer 5

Assisted living

Question 6

Profit

Answer 6

Owners obtain money from the profits of the agency; taxation

Question 7

If the coinsurance is 80/20%, how much does 1). The company pay? 2). The patient pay?

Answer 7

1). 80% 2). 20%

Question 8

Which of the following provides care for terminally ill people who usually have 6 month or less to live?

Answer 8

Hospice

Question 9

Which part of Medicare provides for hospital care, long-term care facilities, home health services, and hospice care?

Answer 9

Part A

Question 10

If someone’s premium is $300 per month, what is their annual premium payment?

Answer 10

$3,600

Question 11

DRG’s

Answer 11

Designed by Congress to lower healthcare cost. A flat rate is reimbursed based on the illness or procedure no matter what the facility charges.

Question 12

Hospice

Answer 12

Services are provided to the terminally ill; those who have 6 months or less to live

Question 13

What must you have with an HMO?

Answer 13

A primary care physician

Question 14

What government agency regulates food and drug products that are sold to the public?

Answer 14

Food and Drug Administration (FDA)

Question 15

Copayment

Answer 15

A payment made by a beneficiary (especially for health services) that is made by an insurer.

Question 16

Medicare

Answer 16

Federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant called ESRD)

Question 17

Non-profit agencies

Answer 17

Most deal with specific diseases or groups of diseases.

Question 18

Food & Drug Administration

Answer 18

A federal agency responsible for regulating the food and drug products sold to the public.

Question 19

Residential care

Answer 19

Nursing home

Question 20

What are the 4 types of hospitals?

Answer 20

General hospitals, specialty hospitals, government hospitals, university/college medical centers

Question 21

Worker’s Compensation

Answer 21

A form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employees right to sue their employer for the tort of negligence.

Question 22

Managed care

Answer 22

Monitors healthcare services to ensure the purpose was appropriate; a second chance is often required.

Question 23

Medicaid

Answer 23

Healthcare program that assists low-income families or individuals in paying for long-term medical and custodial care costs. Medicaid is a joint program, funded primarily by the federal government and run at the state level, where coverages may vary.

Question 24

Tricare

Answer 24

A healthcare insurance system for military dependents and members of the military services that covers care not available through the usual U.S. military medical service or public health service facilities. CHAMPUS was the first federal third-party reimbursement system to pay for care rendered by nurse-midwives and nurse practitioners.

Question 25

World Health Organization

Answer 25

An international governmental agency sponsored by the United Nations. It compiles statistics and investigated serious health problems throughout the world.

Question 26

When you go to the doctor, you may have to pay and amount of money regardless of the cost of the visit. What is this called?

Answer 26

Copay

Question 27

What type of insurance covers accidents, injuries, or diseases that occur in the workplace?

Answer 27

Worker’s compensation

Question 28

Assisted Living Facilities

Answer 28

Independent living; provides basic services (meals/housekeeping); basic medical care

Question 29

Coinsurance

Answer 29

A type of insurance in which the insured pays a share of the payment made against a claim.

Question 30

Local Health Departments

Answer 30

Provides immunization

Question 31

Preferred Provider Organization

Answer 31

Insurance that contracts with doctors to provide medical services at reduced rates, but employees are restricted to using doctors from a list.

Question 32

Which of the following may also be referred to as a nursing home?

Answer 32

Long-term care facility

Question 33

U.S. Department of Health and Human Services (DHHS)

Answer 33

National agencies that advises on health and welfare plans; policies and federal government programs; agencies under DHHS include CDC, FDA, AHRQ

Question 34

In health insurance terminology, what is coinsurance?

Question 35

NIH is a division of which organization?

Answer 35

USDHHS