nurs 4800 midterm and final
hospital budget: personnel
the largest of the budget expenditures is the
workforce or personnel budget because health care
is labor-intensive.
-managers must use historical data while
anticipating incoming fluctuations in disease and
illnesses
- a patient days or volume decreases, managers
must decrease personnel costs in relation to
decrease in volume
hospital budget: operating
involves all managers
reflects expenses that change (up or down) in
response to the volume of service, such as the cost
of electricity, repairs and maintenance, and
supplies
hospital budget: capital
plans for the purchase of buildings or major
equipment, which include equipment that has a life
long (usually greater than 5-7 years), is not used in
daily operations, and is more expensive than
operating supplies
insurance premium
,amount paid on an insurance policy per a given
time period
deductible
a specified amount of money that the insured must
pay before an insurance company will pay a claim
(before it kicks in)
Co-pay
the amount of money the patient has to pay that
the insurance company will not pay
a set fee you pay upfront before a covered medical
service or procedure
Co-insurance
the percentage of money that you are expected to
pay after the deductible is reached
Out-of-pocket maximum
Stated amount out of pocket the insured can pay
for medical costs in a 12-month period before
copayments end.
out of network
Providers or suppliers who do not participate in a
managed care organization or health plan.
managed care
,A system that combines the financing and the
delivery of appropriate, cost-effective health care
services to its members.
HMO
A group plan offering prepaid medical care to its
members
medicare part A
The part of the Medicare program that pays for
hospitalization, care in a skilled nursing facility,
home health care, and hospice care.
medicare part B
The part of the Medicare program that pays for
physician services, outpatient hospital services,
durable medical equipment, and other services and
supplies.
Medicare Part C (Medicare Advantage)
•Replaces and covers expenses found in Part A and
B
•Medicare private fee-for-service plans (PFFS)
•Medicare managed care plans (HMOs and PPOs)
•Medicare specialty plans
medicare part D
Prescription drug coverage
who is covered under medicaid
, Group 1: Low income families
Group 1A: Parents
Group 1B: Children
Group 2: Low-income elderly receiving
Supplemental Security Income
Dually eligible for Medicare and Medicaid
Group 3: Low-income blind or disabled receiving
SSI; primary or dually eligible
private insurance
Insurance individuals and companies voluntarily
pay to cover unexpected losses.
Types of Law
criminal, civil, administrative
civil law
A law that governs relationships between
individuals and defines their legal rights.
criminal law
A law that defines crimes against the public order.
Administrative Law
The body of law created by administrative agencies
(in the form of rules, regulations, orders, and
decisions) in order to carry out their duties and
responsibilities.
Malpractice
hospital budget: personnel
the largest of the budget expenditures is the
workforce or personnel budget because health care
is labor-intensive.
-managers must use historical data while
anticipating incoming fluctuations in disease and
illnesses
- a patient days or volume decreases, managers
must decrease personnel costs in relation to
decrease in volume
hospital budget: operating
involves all managers
reflects expenses that change (up or down) in
response to the volume of service, such as the cost
of electricity, repairs and maintenance, and
supplies
hospital budget: capital
plans for the purchase of buildings or major
equipment, which include equipment that has a life
long (usually greater than 5-7 years), is not used in
daily operations, and is more expensive than
operating supplies
insurance premium
,amount paid on an insurance policy per a given
time period
deductible
a specified amount of money that the insured must
pay before an insurance company will pay a claim
(before it kicks in)
Co-pay
the amount of money the patient has to pay that
the insurance company will not pay
a set fee you pay upfront before a covered medical
service or procedure
Co-insurance
the percentage of money that you are expected to
pay after the deductible is reached
Out-of-pocket maximum
Stated amount out of pocket the insured can pay
for medical costs in a 12-month period before
copayments end.
out of network
Providers or suppliers who do not participate in a
managed care organization or health plan.
managed care
,A system that combines the financing and the
delivery of appropriate, cost-effective health care
services to its members.
HMO
A group plan offering prepaid medical care to its
members
medicare part A
The part of the Medicare program that pays for
hospitalization, care in a skilled nursing facility,
home health care, and hospice care.
medicare part B
The part of the Medicare program that pays for
physician services, outpatient hospital services,
durable medical equipment, and other services and
supplies.
Medicare Part C (Medicare Advantage)
•Replaces and covers expenses found in Part A and
B
•Medicare private fee-for-service plans (PFFS)
•Medicare managed care plans (HMOs and PPOs)
•Medicare specialty plans
medicare part D
Prescription drug coverage
who is covered under medicaid
, Group 1: Low income families
Group 1A: Parents
Group 1B: Children
Group 2: Low-income elderly receiving
Supplemental Security Income
Dually eligible for Medicare and Medicaid
Group 3: Low-income blind or disabled receiving
SSI; primary or dually eligible
private insurance
Insurance individuals and companies voluntarily
pay to cover unexpected losses.
Types of Law
criminal, civil, administrative
civil law
A law that governs relationships between
individuals and defines their legal rights.
criminal law
A law that defines crimes against the public order.
Administrative Law
The body of law created by administrative agencies
(in the form of rules, regulations, orders, and
decisions) in order to carry out their duties and
responsibilities.
Malpractice
