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UHI 3 & 15
Side A
| Question | Answer |
|---|---|
| primary care physician | PCP |
| sate children's health insurance program | SCHIP |
| healthcare effective data & information set | HEDIS |
| point of service | POS |
| health maintenance organization | HMO |
| preferred provider organization | PPO |
| managed care organization | MCO |
| Medicaid Eligibility Verification System | MEVS |
| flexible spending account | FSA |
| early and periodic screening, diagnostic, and treatment services | EPSDT |
| health savings account | HSA |
| second surgical opinion | SSO |
| what is MCO | responsible for health care of enrollees & reimbursement to physicians |
| Medicaid | payer of last resort |
| mother baby claim | baby under mother for 30 days |
| computer/website, POS drive, telephone | 3 ways to verify Medicaid coverage |
| coinsurance, deductible, spin down | 3 things you may be required to pay with Medicaid |
| every time | Medicaid should be verified |
| remittance advice | physician reimbursement form |
| federally mandated & state administrated | Medicaid is |
| dual eligibles | Medicare & Medicaid eligible |
| 19 | Must be under what age for SCHIP |
| gatekeeper | PCP for essential health care services at the lowest possible cost |
| 2 year | children are eligible for Medicaid for |
| adjusted claim | a claim that has payment corrections |
| Medicare | pays before Medicaid |
| voided | should never have been filed |
| low income, categorically needy, medically needy, special groups, children under 6 | Medicaid eligible individuals |
| Aged, blind, disabled, mental institution | SSI recipients eligible for Medicaid |
| 6 months | timely filing for Medicaid |
| PACE (program for all-inclusive care for the elderly | age 55 and over who require a nursing level facility care |
| payer of last resort | Medicaid is always |
| balanced billing | physicians can't bill patient if a balance is owed |
| 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 |
| quality assurance program | includes activities that assess the quality of care provided in a health care setting |
| enrollees | subscribers (policyholders) is another name for |
| fee-for-service | re |
| capitation | provider accepts preestablished payments |
| gag clauses | prevents providers from discussing all treatment options with patients |
Created by:
Stacey_Gantt5
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