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

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


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




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)




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

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