Side A
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| primary care physician | PCP
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| sate children's health insurance program | SCHIP
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| healthcare effective data & information set | HEDIS
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| point of service | POS
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| health maintenance organization | HMO
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| preferred provider organization | PPO
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| managed care organization | MCO
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| Medicaid Eligibility Verification System | MEVS
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| flexible spending account | FSA
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| early and periodic screening, diagnostic, and treatment services | EPSDT
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| health savings account | HSA
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| second surgical opinion | SSO
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| what is MCO | responsible for health care of enrollees & reimbursement to physicians
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| Medicaid | payer of last resort
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| mother baby claim | baby under mother for 30 days
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| computer/website, POS drive, telephone | 3 ways to verify Medicaid coverage
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| coinsurance, deductible, spin down | 3 things you may be required to pay with Medicaid
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| every time | Medicaid should be verified
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| remittance advice | physician reimbursement form
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| federally mandated & state administrated | Medicaid is
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| dual eligibles | Medicare & Medicaid eligible
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| 19 | Must be under what age for SCHIP
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| gatekeeper | PCP for essential health care services at the lowest possible cost
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| 2 year | children are eligible for Medicaid for
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| adjusted claim | a claim that has payment corrections
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| Medicare | pays before Medicaid
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| voided | should never have been filed
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| low income, categorically needy, medically needy, special groups, children under 6 | Medicaid eligible individuals
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| Aged, blind, disabled, mental institution | SSI recipients eligible for Medicaid
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| 6 months | timely filing for Medicaid
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| PACE (program for all-inclusive care for the elderly | age 55 and over who require a nursing level facility care
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| payer of last resort | Medicaid is always
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| balanced billing | physicians can't bill patient if a balance is owed
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| preauthorization required | elective inpatient admission, emergency inpatient admission, more than 1 preoperative day, outpatient procedures, days exceeding state hospital stay limitation, extension of inpatient days
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| quality assurance program | includes activities that assess the quality of care provided in a health care setting
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| enrollees | subscribers (policyholders) is another name for
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| fee-for-service | re
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| capitation | provider accepts preestablished payments
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| gag clauses | prevents providers from discussing all treatment options with patients
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Created by:
Stacey_Gantt5
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