Pay attention to HL7 codes
Organizations
Medicare
- Federal, a dept of HHS
- Serves over-65 and disabled
Medicaid
- Federally monitored
- Run by states so has many names
- For low-income and eligible families
Tricare
- For active-duty members of US military
FEHB
- Federal Employee Health Benefits Program
- For federal employees, retirees and their families
Organization/Facilities Types
Hospitals
Inpatient (admitted) vs. Outpatient
General Hospital – required to provide diagnosis and treatment for medical services including radiology, lab services and surgery.
Specialty Hospital – provides treatment for specific disorders such as cancer, burns or women’s health
Rehabilitation Hospital – provides diagnosis, treatment, restorative and adjustment services to the disabled
Psychiatric Hospital – provides diagnosis and treatment for individuals with mental illness or behavioral health disorders
Private Practices
Practitioners practice medicine without supervision (doctors, nurse practitioners)
Providers are in supervised settings (nurses, aides)
Acute Care Facility
Provides medical, surgical, pediatric and obstetric services that require fewer than 30 days hospital stay.
Assisted Living Facility
For elderly or those who need assistance with activities of daily living (ADL)
HMO
Health Maintenance Organization
Provides healthcare services for fixed, prepaid reimbursement.
Providers and subscribers voluntarily enroll.
Home Health Care
Often for IV care or PT
Hospice
Care for terminally ill patients, either at home or in facilities.
24/7 care
Pharaceuticals
Medical/hospital equipment
Medicare/Medicaid will reimburse most hospice costs for those eligible.
Nursing Homes/Convalescent Hospitals
Long-term
Often run by Director of Nursing, an RN
Staffed by LPNs and non-licensed nursing assistants
For Medicare reimbursement, must meet criteria for a Skilled Nursing Facility (SNF)
Nonacute Care Facility
aka Long Term Care Facility
For individuals w/ long-term illnesses requiring hospital stays of over 30 days.
Alzheimer’s Disease etc.
POS
Point of Service healthcare plan
Patient permitted to choose a provider each time healthcare services are needed.
PPO
Preferred Provider Organization
A network of providers that give a discount rate in return for higher volume.
Subacute Care Facility
Provides treatment for patients with an acute illness or injury on top of a chronic illness, like surgery patients who get pneumonia.
Surgical Centers and Ambulatory Surgical Centers (ASCs)
Outpatient and inpatient