NURS 412 Lecture Notes - Lecture 3: Health Maintenance Organization, Preferred Provider Organization, Group Insurance
Document Summary
Standard payment: precertification (preapproval) process: health care providers have to prove that treat(cid:373)e(cid:374)t is (cid:862)(cid:373)edically (cid:374)ecessary(cid:863, health maintenance organization (hmo): contract with health care providers within organization, provide health care services for a prepaid fee, focus on prevention. In order to reduce costs: payment specified according to diagnosis, later adopted by private, group insurers, because of this, patients are discharged sooner, sicker, and needing extended and. Medicaid: home care: care for low income, federally funded, state-regulated plan, reimbursements are given only to providers, facilities approved by the state agency, many opt out of participation. Patients vs residents vs clients: patients, hospital, sub-acute care facilities, clinic, extended care facility, residents, long-term care facility (ltc, nursing home, assisted-living facility, clients, receives care from his/her own home, home health care agency. Acute illness: rapid onset and relatively short recovery time: usually unexpected. Medical patients: have illness or condition that is treated with interventions other than.
