Assignment: Diagnosis Related Group

Assignment: Diagnosis Related Group
Assignment: Diagnosis Related Group
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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
[removed] : Managed care’s way of classifying patients by diagnosis, average length of hospital stay, and therapy received
[removed] : 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
[removed] : Employees become part of their employer’s group insurance plan and the employer subsidizes the monthly premiums
[removed] : Emphasized environmental sanitation to stop the spread of epidemic diseases
[removed] : Each individual service or treatment is paid and billed separately
[removed] : A derogatory term for a medicine, especially an ineffective one, prepared by an unqualified person
[removed] : Involves bundled payments when physicians are paid for a series of treatments that are not billable individually
[removed] : Preventing unnecessary specialized care
[removed] : Global mission of health protection, prevention, and preparedness
[removed] : Practice of recognizing that different groups have unique health experiences and needs
[removed] : Enter into contracts with hospitals and healthcare professionals to provide healthcare to the beneficiaries in exchange for a negotiated rate per patient
[removed] : Amount of payment is determined prospectively, before the service is rendered
[removed] : 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
[removed] : Hospitals, skilled nursing facilities and home health agencies are reimbursed on an “episode of care basis”
[removed] : 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
[removed] : 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
[removed] : 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
[removed] : Mr. Jenkins owns a hardware in 1880s and starts to treat patients
[removed] : Dr. Thomas receives the same amount per patient per month whether the patient is receiving services or not
[removed] : Jan goes to the primary care physician in order to receive a referral to a specialist
[removed] : 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
[removed] : Dr. Thomas reports to this entity that she has diagnosed a patient with Tuberculosis
[removed] : Jan is employed by ACME Tile, receives health insurance as a benefit and contributes $100/month to the premium
[removed] : Promotes a Youth advertising campaign to promote healthy eating and exercise
[removed] : Patient presents to the ER with COPD and is admitted to the hospital. The hospital is reimbursed based on the COPD Diagnosis
[removed] : Dr. Thomas educates and advises patients on quitting smoking, exercise, and health eating. Dr. Thomas receives reimbursement for meeting quality measures