Chapter 9 10 11 and 13
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| PPS | Prospective payment system - to control cost of inpatient care
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| AHCCCS | Arizona Health Care Cost Containment System
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| Propspective price base rate | Is/Are associated with particular categorize inpatient and establish payer rates
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| What are the "BLUES" known as | Pioneer in nonprofit prepaid health care
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| ADHS | Arizona Department of Health Services
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| OCR | Optical character reader
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| When was Medicate implemented | 1966
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| Retrospective reasonable cost system means | That for inpatient care to payer, hospital reported actual inpatient charges billed payers "after discharge"
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| ambulance fee schedule | established payment system for ambulance services to Medicate beneficiaries
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| Part of the CMS/Federal Payment System programs are? | CHAMPVA, Medicaid and Medicare
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| Home Health Prospective Payment System | Establish reimbursementrates for each 60 day episode of home health care
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| Medicare Physician Fee Schedule (MPFS) divides three components | Physician Work, practice expense, and malpractice expense. RVU's by geographic adjustment factors (GAF)
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| Non-PAR | Physician charges no more than limiting charge - calculated by multiplying reduced MPFS by 115% on a non-assigned claim
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| Included in Nurse Practitioners (NP) | Nurse, midwives, clinical psychologist and clinical social workerC
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| Who all is required to "accept assignment" | Nurse Practitioners (NP, Clinical Nurse Specialist (CNS), Physician Assistants (PA)
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| 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
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| Advanced Beneficiary Notice | Waiver required by Medicare for all outpatient services that might not be covered by Medicare
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| Operative Reports | Dictated narrative description of minor or major surgery procedure
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| 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
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| Assignment of Benefits | Sends reimbursement directly to the provider
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| What are the common errors that cause delay in processing of claims | Typographic, Omissions, Attachments without patient identification
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| Accepting Assignment is | Accept the payment the payer reimburses excluding co-pays, co-insurance and deductibles
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| 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
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| AHCCCS was created to? | Defray cost of indigent health care in Arizona
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| AHCCCS is first? | State-wide Medicaid managed care system in the Nation
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| What is (ALTCS) Arizona Long Term Care System | Provides payment for elderly, physically & developmentally disable population
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| Kidscare is known as | State children's health insurance program 75% federally funded for uninsured children in the state
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| Is there a monthly premium due for coverage under the state children's health insurance plan | YES
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| FEHBP (Federal Employee Health Benefits Program) | Is part of BC/BS
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