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Health care delivery systems, payment sources, QIA, telemedicine

Health care delivery systems, payment sources, QIA, telemedicine. Objectives: Student will evaluate the use of tele -health in the delivery of health care. Student will analyze various quality improvement initiatives. Student will compare and contrast the various

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Health care delivery systems, payment sources, QIA, telemedicine

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  1. Health care delivery systems, payment sources, QIA, telemedicine Objectives: Student will evaluate the use of tele-health in the delivery of health care. Student will analyze various quality improvement initiatives. Student will compare and contrast the various Health care delivery systems and payment sources

  2. How has health care evolved in the United States? • Timeline of legislative acts affecting health care.

  3. Contents of Medical Record • Registration Form- Name, address, ss#, insurance #, phone number etc.. • Medical History • Test Results and graphic charts (including vital signs) • Records from other physicians/hospitals • Diagnosis, tx plans, progress notes • Operative Report (record of surgeries) • Informed Consent (permission for invasive procedures) • Discharge Summary – condition at discharge and follow up care

  4. Quality Improvement Initiative • Goal: track and improve the quality of all aspects of medical practice, record keeping, employee evaluations, finances, legal matters, public image, staff morale, insurance issues and patient education • Contents: written policies on standards of patient care and professional standards, quality control program, training and CEU’s, instrument maintenance procedures, documentation requirements, evaluation methods

  5. Payment Sources • Universal Health care insurance claim form is the HCFA-1500 • DRG- groups of procedures or tests likely to be covered by insurance. • There are almost 500 separate DRG’s

  6. Federally funded insurance • Medicare- 65 or older • Medicaid- low income, blind, disabled • Military- champus/Tricare • Worker’s Compensation- on the job injuries- paid for by employer

  7. Private Insurance • Ex: Blue Cross/Blue Shield- can use any providers coverage varies by areas of the country. Varying amounts of dedctible and then % of copay

  8. HMO/PPO • HMO- Health Maintenance org. Gatekeeper • PPO- Preferred Provider Org.- list of providers • Deductible • Co-pay • %

  9. Health Care Delivery Systems • Hospitals • Clinics- school, corporate • LTC • ECF • Hospice- • Laboratories • Outpatient facilities- diagnostic clinics, surgical clinics, dialysis clinics, rehabilitation clinics • Telehealth or Telemedicine

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