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
