FBLA health care administration test – Flashcards
65 test answers
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NCQA
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Reviews and accredits health plans
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ASC
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Ambulatory services center. Line by line billing allows for less costs
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Adverse selection
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Attracting patients that are sicker than usual
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Admission Certification
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Admitting patients that need more care
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Single Payer System
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Government Run. Care Triad (Cost, quality, access)
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Evidence Based Medicine
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Uses EMR of patient to determine the best treatment
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National Labor Relations Act
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Allows hospital/heath care providers to use bargaining units
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Fair Labor Standards Act of 1938
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Establishes Minimum Wage, Ages, overtime pay for workers
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Equal Pay Act
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Pay equality amongst genders
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HEDIS
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Compares health plan performance
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OASIS
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Reimbursement for home health care plans
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UHDDS
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Uniform health discharge data set. Needed for Medicare reporting
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OSHA
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Establishes and regulates workplace safety
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Protected Health Information
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Records of a patient's past and present health condition, how the care was provided and how the patient paid
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HIPPA
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Health Information Privacy and Portability act
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Provisions of HIPPA
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Cannot be denied coverage for group insurance, coverage wait cannot exceed 12-18 months, safeguards electronc information, privacy of health records
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Copay
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Payment defined by policy that grants access to the treatment
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Premiums
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Money paid to insurers to negate the risk of loss. Lower payments result in high treatment costs
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HMO
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Health Maintenance Organization: Individuals pay a fixed amount and get access to facilities within the plan
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PPO
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Typical insurance style. Individuals pay a fee for service along with copay and deductables through a network of providers
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POS
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Similar to a HMO, but with extentions through payment similar to a PPO plan
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HDHP
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Insurance plan for high risk individuals. Low premium but has high deductables
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Medicare
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Health care plan entitled to people 65 and older
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Medicaid
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Health care plan granted by states to low income individuals
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ERISA
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Act that allows employers to set up insurance plans. Also allows funding for Medicaid
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Medicare Part A
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Inpatient coverage, home health, hospice. Also defines limits of Medicare usage
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Medicare Part B
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Outpatient care. Extends Medicare to supplemental treatments, and physicians
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Medicare Part C
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Allows people with Medicare to enroll in supplemental indemity plans
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Medicare Part D
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Medicare drug coverage
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TRICARE
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Military health insurance progra
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Managerial Accounting
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Financial data for internal users: Board, executives and managers
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Financial Accounting
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Financial data for external users: Stockholders, lenders, insurers, government
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HCPCS
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Healthcare Common Procedure Coding System: Codes used for outpaint services and supplies
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EMR
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Electronic record for individual patients
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EHR
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Electronic record for a population
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Triage
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Determining which patients to admit first
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Systemic
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Disease affects multiple organs
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NPDB
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Records of practitioner credentials
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DNR
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Do not recessetate order
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Stark Law
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Prohibits physicians from making referrals to Medicare
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Affadavit
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Sworn statement of facts in an incident
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In Loco Parentis
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Court makes decesions in place of the parents
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Credits
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Positive account changes. Right (middle) side of ledger
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Debits
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Negative account changes. Left side of ledger
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Accounts Receivable
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Payers who still need to send funds. Assets are still accessable, but not tangible (liquid)
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ICD-9 Codes
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International Disease Classification codes
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ICD-9 Codes 0-739
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Codes for diseases or disorders
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ICD-9 Codes 740-999
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Codes for injuries
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Current Liabilities
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Expenses to be paid
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SCHIP
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Program that helps needy families with children get insurance
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3 ft Radius
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Droplet isolation zone
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Preliminary Screening
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Interview of patient to obtain signs and symptoms
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Antiseptic
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Inhibits microbrial growth on surfaces and tissues
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Disinfectants
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Destroy microbes on non living matter
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PPACA
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"Obamacare"
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POMR
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Helps track treatments in medical records
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Infection Timeline
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Incubation, Itching/chills phase, peak stage with vomiting/aches/chills, recovery stage
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Jurisprudent
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Knowledgable on the law
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CPT-4
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Codes for treatments
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NPI
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8-20 digit number for Medicare providers
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Patient Bill of Rights
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Access to closest ER, choice of doctor, pediatrician, etc
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