HCS management Research Flashcards
Descriptive study design
Describe and analyze a phenomenon
Experimental study design addresses?
Intervention effectiveness because participants are assigned to different groups to determine effects of intervention
A standardized recommended intervention protocol for a specific diagnosis
Clinical/ critical pathway
Provider is paid on a monthly basis for each member regardless if no healthcare is delivered.
Per member per month.
Capitation
The descriptive categories that determine the level of payment at a per case rate.
DRGs
Diagnostic related groups.
Most common form of managed care. You have to see doctor within the network and get referrals for specialists.
HMO
Health maintenance organization
Managed care that offers a choice for providers, which in turn decreases reimbursement percent.
PPO
Preferred provider organization
The nationwide payment schedule that determines the medicare payment for each inpatient stay based on DRGs
PPS
Who qualifies for medicare?
65 and up
Permanent kidney failure
Long term disability over 2yrs; maybe
What settings are covered under part A?
Inpatient SNF Home health Rehabs Hospice
Primary difference between part A and part B
Part A- 5days pw
Part B- 3days pw
OT reimbursement in SNFs is based upon?
RUGs
In home care what has to be established before OT can begin?
Intermittent nursing OT or Speech
In home health, What eval is administered to verify medicare eligibility?
OASIS
Name 4titles under ADA
Employment
Public services
Public accommodations
Telecommunications