Unit 10 Flashcards
- What are the benefits of value-based care?
More emphasis on patient outcomes
____ focused more towards larger healthcare systems
C. Accountable Care Organizations
____ pay for performance
B. Value-Based Care
____ temporary and experimental value-based care models
D. APM -(Alternative Payment Methods)
____ aimed towards smaller providers
A. Merit-based improvement program
What is the difference between traditional care models and integrated care models?
Traditional - PCM left out
Integrated - PCM integrated in the patient care process
What are the 3 phases impacting the current generation of value-based systems?
Phase I: Integration into practice workflow and culture.
Phase II: Shared-Decision Making.
Phase III: Accountability for Outcomes:
What is the purpose of insurance reimbursement systems?
Healthcare reimbursement is a payment system that receives, pays, and regulates healthcare provider claims.
- What is retrospective payment: Charge based reimbursement (fee for service)?
The amount paid is determined by (or based on) what the provider charged or said it cost to provide the service after tests or services had been rendered to beneficiaries
- What is regulatory compliance?
Complying with regulations
- Regulatory bodies:
a. CMS and CHIP
b. AHRQ
c. JCAHO
d. CDC
e. FDA
Centers for Medicare and Medicaid and the State Children’s Insurance Program
Agency for Healthcare Research and Quality
Joint Commission on Accreditation of HealthCare Organizations
Centers for Disease Control
Food and Drug Administration
What is the purpose of ICD-10?
A disease classification system that tracks statistics by mapping diseases into trends.
What is the purpose of a Diagnosis-related group (DRG)?
This classification standardizes prospective payment systems to contain costs.
What is the purpose of Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)?
Are used in psychiatric care environments.
