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

 

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

Nursing Research And Evidence Based Practice With Picot Question

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