Promotes a Youth     advertising campaign to promote healthy eating and exercise

Match the health care definition   with the term
  (Points : 13) 

Potential Matches:

1 : Cost sharing

2 : Managed Care Organizations   (MCO)

3 : Fee-for-Service (FFS)

4 : Diagnosis Related Group (DRG)

5 : Cultural Competency

6 : Capitation

7 : Prospective Payment System   (PPS)

8 : Pay-for-performance

9 : Centers for Disease Control   (CDC)

10 : Public Health

11 : Explanation of Benefits (EOB)

12 : Nostrum

13 : Gatekeeping

   Answer 

1 : Managed care’s way of   classifying patients by diagnosis, average length of hospital stay, and   therapy received

2 : Summarizes what the insurance   company paid the provider, how much the patient owes, and provides an up-to-date   status of the patient’s annual deductible and out of pocket expenses

3 : Employees become part of their   employer’s group insurance plan and the employer subsidizes the monthly   premiums

4 : Emphasized environmental   sanitation to stop the spread of epidemic diseases

5 : Each individual service or   treatment is paid and billed separately

6 : A derogatory term for a   medicine, especially an ineffective one, prepared by an unqualified person

7 : Involves bundled payments when   physicians are paid for a series of treatments that are not billable   individually

8 : Preventing unnecessary   specialized care

9 : Global mission of health   protection, prevention, and preparedness

10 : Practice of recognizing that   different groups have unique health experiences and needs

11 : Enter into contracts with   hospitals and healthcare professionals to provide healthcare to the   beneficiaries in exchange for a negotiated rate per patient

12 : Amount of payment is   determined prospectively, before the service is rendered

13 : Reimbursement models aimed at   improving the quality, efficiency, and overall value of health care

Match the real word example with     the term
    (Points : 13) 

Potential Matches:

1 : Nostrum

2 : Fee-for-Service

3 : Public Health

4 : Capitation

5 : Diagnosis Related Group     (DRG)

6 : Gatekeeping

7 : Prospective Payment System     (PPS)

8 : Pay-for-Performance

9 : Cost Sharing

10 : Explanation of Benefits     (EOB)

11 : Managed Care Organization     (MCO)

12 : Cultural Competency

13 : Centers for Disease Control     (CDC)

   Answer 

1 : Hospitals, skilled nursing     facilities and home health agencies are reimbursed on an “episode of care     basis”

2 : Dr. Thomas exams a patient     named Jan. Jan’s health insurance provider is Blue Cross Blue Shield.     Services provided included a Chest X-ray, yearly physical, and removal of a     mole. Dr. Thomas receives reimbursement for each service rendered

3 : Dr.     Thomas exams a patient named Jen. Jen’s health insurance provider is     HealthPlus of Michigan. Services provided included a yearly physical,     removing a mole and ordering of labs and chest x-ray. Dr. Thomas receives     reimbursement based on a contracted discounted rate

4] : Jan receives a report from     the health plan listing the blood work, chest x-ray and physical she     received at her primary care physician’s office

5 : Mr. Jenkins owns a hardware     in 1880s and starts to treat patients

6 : Dr.     Thomas receives the same amount per patient per month whether the patient     is receiving services or not

7] : Jan goes to the primary     care physician in order to receive a referral to a specialist

8 : Jan is in severe pain     evidenced by Nursing assessment of raised blood pressure, facial grimacing,     and holding abdomen. However, she does not complain of pain

9 : Dr. Thomas reports to this     entity that she has diagnosed a patient with Tuberculosis

10 : Jan     is employed by ACME Tile, receives health insurance as a benefit and     contributes $100/month to the premium

11 : Promotes a Youth     advertising campaign to promote healthy eating and exercise

1 : Patient presents to the ER     with COPD and is admitted to the hospital. The hospital is reimbursed based     on the COPD Diagnosis

13: Dr. Thomas educates     and advises patients on quitting smoking, exercise, and health eating. Dr.     Thomas receives reimbursement for meeting quality measures