dynamics 3

Question 1

What is the difference between an HMO and an EPO?

Answer 1

An EPO doesn’t require primary care providers to make referrals to specialist

Question 2

What is the main con of an HMO?

Answer 2

You can only use physicians within the HMO group

Question 3

What is distributive health care?

Answer 3

Advances in medical technology such as mobile units and telemedicine

Question 4

What is capitation?

Answer 4

Paying the practitioner or hospital a fixed amount for a specific service

Question 5

What has changed the healthcare system and created new ways of paying for healthcare?

Answer 5

Distributive health care

Question 6

What is Medicaid?

Answer 6

The federal-state health insurance for the low-income

Question 7

What is a “Fee for service”

Answer 7

The provider is financially rewarded for volume rather than quality and cost

Question 8

What did medicare benefit payments do in 2014?

Answer 8

Totaled 597 billion, 25% covered inpatient services, and the other 25% covered private insurance

Question 9

What is the difference between the benefits of Medicare and private insurance?

Answer 9

The government pays the healthcare bills instead of the individual or private insurance

Question 10

What do PPOs cover?

Answer 10

Cover care provided both inside and outside the plan’s provider network

Question 11

What are examples of capitation for private insurance?

Answer 11

Health Maintenance Organizations(HMOs)

Question 12

What is the largest public health insurance program?

Answer 12

Medicaid

Question 12

What was the first pre-payment plan to cover physicians?

Answer 12

Blue cross-Blue Shield

Question 13

What bill was passed where hospitals are paid a set amount for each patient in any of the established DRGs?

Answer 13

Prospective payment bill

Question 14

The first managed care insurance programs were started with ____

Answer 14

HMOs

Question 15

What is managed care?

Answer 15

HMOs, PPOs, and EPOs

Question 16

What was the traditional method of reimbursement for health services before the ACA?

Answer 16

Fee for service and payment for each service at the time of service

Question 17

What is a PPO?

Answer 17

a group of providers who have voluntarily joined together to render healthcare or a group of providers whom a payer for an arrangement has organized

Question 18

What is an HMO?

Answer 18

The first managed care insurance program/can not see out-of-network providers

Question 19

What is Blue Cross?

Answer 19

The first private hospital insurance plan

Question 20

What is an EPO?

Answer 20

A program that doesn’t require that the primary care provider make a referral to a specialist

Question 21

What is CHIP?

Answer 21

Healthcare coverage for low-income children

Question 22

What is a preferred provider?

Answer 22

An organization of a group of providers who join together on a contract to deliver medical services

Question 23

What is the ACA?

Answer 23

Individuals without access to private insurance through an employer can purchase health insurance through an exchange and receive government subsidies

Question 24

What is Medicare?

Answer 24

A federal health program for people 65 years and older and certain disabled people younger than 65