HS 285 Final Exam

DO

Doctor of Osteopathy

HIPAA

[Health Insurance Portability and Accountability Act] protects health insurance coverage for workers and their families a spouse loses or changes jobs

Depreciation

a reduction in the value of an asset with the passage of time

Explain the meaning of the term The "C suite

suite-The number one position is "Chief Executive Officer." The number two position is "Chief Operating Officer." "Chief Financial Officer" is a term that is used consistently in all naming devices.

Laparoscopy

surgical proceedure in which a fiber-optic instrument is inserted through a small incision of the abdominal wall to view organs and allow for surgical procedures to be performed.

When are medical staff privileges mandatory?

When the governing board requires it-always

False Claims Act

any activity by which the Federal Government may be defrauded.

Please define and differentiate between (a) a multihospital system (b) an integrated healthcare network

(a) multi-hospital system is any combination of two or more acute-care facilities under one ownership entity (b) organization that arranges to provide continuation of services between centers within network

Define vertically integrated healthcare network and one example

2 or more hospitals with their own captive insurance. Intermountain healthcare

ADLs

Activities of Daily Living

ABMS

American Board of Medical Specialties

ACHE

American College of Healthcare Executives

In the management structure of a hospital, who are the two people that the CFO can report to?

CEO and Board of Directors

CRNAs

Certified Registered Nurse Anesthetists

Fill in the blanks in the following definition of tort. "A ____ committed against a __ or __ excluding __.

civil wrong, person, property, breach of contract

EMTALA

Emergency medical treatment and labor act- Stopped patients from being turned away for lack of insurance or proof of being able to pay for care

Diagram the organization of the medical staff in a provider organization

Governing board, medical staff president/medical director, general surgery, cardiology, radiology, psychiatry, etc.

What is managed care and what is an example of a managed care plan?

Guaranteed coverage at specific care centers for a fixed annual premium, HMOs

HMO

Health Maintenance Organization

HFMA

Healthcare Finance Management Association

Net Revenue

Income after company's costs of running, taxes, etc are taken out

MGMA

Medical Group Management Association

What single feature distinguishes an integrated healthcare network from a multi-hospital system?

Level of management and inclusion of healthcare insurance plans

Is a physician state licensure mandatory or voluntary?

Licensure is required in all states, but differs in its requirements from state to state. It is required for a physicians before they can provide care.

Name the two national organizations that represent(advocate for) (A) not-for-profit hospitals, and (B) for-profit hospitals.

Not-for-profit: American hospital association (AHA), For-Profit: Federation of American Hospitals [FAH]

OIG

Office of Inspector General

OIG law

Office of Inspector General-actively persecutes suspected acts of fraud in medicare and abuse

What does Medicare part A, part B, and part D cover?

Part A: Inpatient, Part B: Outpatient, Part D: Prescription Drug Coverage

PPO

Preferred Provider Organization

Anti-Kickback

Prevent physician self-referral

Define the following term and describe how it works in the healthcare industry. Co-pay or Co-insurance-

The amount one pays out of pocket when going for a doctor's visit

Define the following term and describe how it works in the healthcare industry. Premium

The amount paid for the privilege of health insurance (usually in monthly payments)

Gross Revenue

all of the income from sales without anything taken out

Define the following term and describe how it works in the healthcare industry. Deductible

an amount that needs to be paid by the patient before insurance will step up and pay for medical expenses

Capital

financial assets or the financial value of assets

The board is charged with establishing the ____ and ____and with the hiring and supervising of the ____.

mission, policies, CEO

Revenue

money that comes into a company from sales and services provided

IRB

institutional Review Board

Patient Protection and Affordable Care Act (OBAMACARE)

provide free healthcare for more people

What role(s) does the federal government play in the US healthcare?

regulate

Expense

to charge

Define multi-hospital system and give one example

two or more hospitals managed by a central organization. Mayo Foundation

A governing board has____authority/accountability over the hospital (or other provider entity). They delegate the responsibilities for ____ to the medical staff and they delegate the responsibility for ____ to the CEO. Under this delegated responsibility, the medical staff reviews application by physician for ____ and ____.

ultimate, patient care, management, credentialing, privileging

Is board certification for physician mandatory or voluntary? Identify the entity that gives the exam and the certificate

voluntary, given by the member speciaty board, and certificate from ABMS