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MAP114 Quiz

Chapter 9 10 11 and 13

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
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