Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
MAP114 Quiz
Chapter 9 10 11 and 13
| Question | Answer |
|---|---|
| PPS | Prospective payment system - to control cost of inpatient care |
| AHCCCS | Arizona Health Care Cost Containment System |
| Propspective price base rate | Is/Are associated with particular categorize inpatient and establish payer rates |
| What are the "BLUES" known as | Pioneer in nonprofit prepaid health care |
| ADHS | Arizona Department of Health Services |
| OCR | Optical character reader |
| When was Medicate implemented | 1966 |
| Retrospective reasonable cost system means | That for inpatient care to payer, hospital reported actual inpatient charges billed payers "after discharge" |
| ambulance fee schedule | established payment system for ambulance services to Medicate beneficiaries |
| Part of the CMS/Federal Payment System programs are? | CHAMPVA, Medicaid and Medicare |
| Home Health Prospective Payment System | Establish reimbursementrates for each 60 day episode of home health care |
| Medicare Physician Fee Schedule (MPFS) divides three components | Physician Work, practice expense, and malpractice expense. RVU's by geographic adjustment factors (GAF) |
| Non-PAR | Physician charges no more than limiting charge - calculated by multiplying reduced MPFS by 115% on a non-assigned claim |
| Included in Nurse Practitioners (NP) | Nurse, midwives, clinical psychologist and clinical social workerC |
| Who all is required to "accept assignment" | Nurse Practitioners (NP, Clinical Nurse Specialist (CNS), Physician Assistants (PA) |
| medically managed means | A particular diagnosis may not have received direct treatment during visit, but it affects what the provider does and must be considered when determining treatment for other conditions |
| Advanced Beneficiary Notice | Waiver required by Medicare for all outpatient services that might not be covered by Medicare |
| Operative Reports | Dictated narrative description of minor or major surgery procedure |
| SOAP | S=Subjective contains chief complaint, O=Objective measurable observation by physician exam or diagnostic testing, A=Assessment diagnosis & rationale for it, P=Plan statement of physicians future plans for workup & medical management of case |
| Assignment of Benefits | Sends reimbursement directly to the provider |
| What are the common errors that cause delay in processing of claims | Typographic, Omissions, Attachments without patient identification |
| Accepting Assignment is | Accept the payment the payer reimburses excluding co-pays, co-insurance and deductibles |
| Federal Privacy Act | Prohibits a payer form notifying the provider about paid unassigned claims or rejected unassigned claims and payment sent directly to the patient/policy holder |
| AHCCCS was created to? | Defray cost of indigent health care in Arizona |
| AHCCCS is first? | State-wide Medicaid managed care system in the Nation |
| What is (ALTCS) Arizona Long Term Care System | Provides payment for elderly, physically & developmentally disable population |
| Kidscare is known as | State children's health insurance program 75% federally funded for uninsured children in the state |
| Is there a monthly premium due for coverage under the state children's health insurance plan | YES |
| FEHBP (Federal Employee Health Benefits Program) | Is part of BC/BS |
Created by:
bdee
Popular Insurance sets