C425 Healthcare Delivery, Regulation, and Compliance
(WGU) Exam 2022 with complete solution
Capitation A
covers all services an enrollee may need during an entire year
Market Justice
most equitably distributed through the market forces of supply and demand, rather than
government interventions. Distributed on the basis of willingness and ability to pay
Social Justice
An ideal that embraces all aspects of civilized life and that is linked to fundamental
notions of fairness and to cultural beliefs about right and wrong.
defensive medicine
Ordering more tests and procedures than are necessary in order to protect physicians
from a lawsuit.
medical model
emphasizes clinical diagnosis and medical intervention in the treatment of diseases or
symptoms. Health is defined as lack of illness
National Health Insurance
course of care delivered by providers (Canada)
National Health System
Great Britain taxes support the system, but government also manages the infrastructure
for healthcare delivery
Socialized Health Insurance
government mandated contributions by employers and employees finance health care
(Germany)
Acute Care
relatively severe, short duration, often treatable. Ex. stroke
Chronic Care
continuing for a long time
Planned Rationing
The government making deliberate attempts to limit the supply of health care services
Medicare
Benefit period = 60 days after admitted
Pt B: cover physicians bill, small premiums for elderly
Premiums are income based
Part D: Prescription Drug coverage
Voluntary, w monthly premium
1973- expanded to non elderly disabled, end stage renal disease patients. Financed by
pay roll taxes
American Medical Association
protect the interests of physicians, organized medicine. Supported licensing
discouraged employment by hospitals and insurance companies
Globalization
various forms of cross border economic activities
Medicaid
, Eligible poor, financed through federal matching funds to the states
Each state has its own criteria for eligibility based on income, bank account, property
and assets
Federal law covers: low income elderly, blind, disabled, children in low income families.
Means tested program
provider-induced demand
Artificial creation of demand by providers that enables them to deliver unneeded
services to boost their incomes.
Deductible
Amount you must pay before you begin receiving any benefits from your insurance
company
Centers for Medicare and Medicaid Services (CMS)
provide clarification and interpretation of complex provisions of the law. Promotes
consistency in
interpretation between states
individual private insurance
price based on how risky your life is
fee-for-service
get paid per individual service
prospective reimbursement
pre-established criteria to determine the amount of
reimbursement
Group Insurance
A type of health insurance in which all those insured have the same coverage and pay a
set premium through an organization
Self-insurance
big companies budget funds to pay medical claims incurred by employees
Office of National Coordinator (ONC)
The principal federal entity charged with coordination of nationwide efforts to implement
and use the most advanced health information technology and the electronic exchange
of health information.
Food and Drug Administration (FDA)
a federal agency charged with enforcing regulations against selling and distributing
adulterated, misbranded, or hazardous food and drug products
Accreditation
encourage organization to make improvement efforts (optional)
Licensure
A mandatory credentialing process established by law, usually at the state level, that
grants the right to practice certain skills and endeavors
Resource-Based Relative Value Scale (RBRVS)
method to reimburse physicians according to relative value assigned to each physician
service Complex formula based on time, skill, and intensity
re-distributive policy
A type of policy that takes benefits (usually through taxes) from one group of Americans
and gives them to another (usually through spending).
Capitation
(WGU) Exam 2022 with complete solution
Capitation A
covers all services an enrollee may need during an entire year
Market Justice
most equitably distributed through the market forces of supply and demand, rather than
government interventions. Distributed on the basis of willingness and ability to pay
Social Justice
An ideal that embraces all aspects of civilized life and that is linked to fundamental
notions of fairness and to cultural beliefs about right and wrong.
defensive medicine
Ordering more tests and procedures than are necessary in order to protect physicians
from a lawsuit.
medical model
emphasizes clinical diagnosis and medical intervention in the treatment of diseases or
symptoms. Health is defined as lack of illness
National Health Insurance
course of care delivered by providers (Canada)
National Health System
Great Britain taxes support the system, but government also manages the infrastructure
for healthcare delivery
Socialized Health Insurance
government mandated contributions by employers and employees finance health care
(Germany)
Acute Care
relatively severe, short duration, often treatable. Ex. stroke
Chronic Care
continuing for a long time
Planned Rationing
The government making deliberate attempts to limit the supply of health care services
Medicare
Benefit period = 60 days after admitted
Pt B: cover physicians bill, small premiums for elderly
Premiums are income based
Part D: Prescription Drug coverage
Voluntary, w monthly premium
1973- expanded to non elderly disabled, end stage renal disease patients. Financed by
pay roll taxes
American Medical Association
protect the interests of physicians, organized medicine. Supported licensing
discouraged employment by hospitals and insurance companies
Globalization
various forms of cross border economic activities
Medicaid
, Eligible poor, financed through federal matching funds to the states
Each state has its own criteria for eligibility based on income, bank account, property
and assets
Federal law covers: low income elderly, blind, disabled, children in low income families.
Means tested program
provider-induced demand
Artificial creation of demand by providers that enables them to deliver unneeded
services to boost their incomes.
Deductible
Amount you must pay before you begin receiving any benefits from your insurance
company
Centers for Medicare and Medicaid Services (CMS)
provide clarification and interpretation of complex provisions of the law. Promotes
consistency in
interpretation between states
individual private insurance
price based on how risky your life is
fee-for-service
get paid per individual service
prospective reimbursement
pre-established criteria to determine the amount of
reimbursement
Group Insurance
A type of health insurance in which all those insured have the same coverage and pay a
set premium through an organization
Self-insurance
big companies budget funds to pay medical claims incurred by employees
Office of National Coordinator (ONC)
The principal federal entity charged with coordination of nationwide efforts to implement
and use the most advanced health information technology and the electronic exchange
of health information.
Food and Drug Administration (FDA)
a federal agency charged with enforcing regulations against selling and distributing
adulterated, misbranded, or hazardous food and drug products
Accreditation
encourage organization to make improvement efforts (optional)
Licensure
A mandatory credentialing process established by law, usually at the state level, that
grants the right to practice certain skills and endeavors
Resource-Based Relative Value Scale (RBRVS)
method to reimburse physicians according to relative value assigned to each physician
service Complex formula based on time, skill, and intensity
re-distributive policy
A type of policy that takes benefits (usually through taxes) from one group of Americans
and gives them to another (usually through spending).
Capitation
