What is the reason that Medicaid enrolls members in managed care plans?
List the three reasons Medicaid enrolls members in managed care plans. fills the gaps in what Medicare does not pay by serving as a wraparound. Beneficiaries with the lowest incomes and assets receive the greatest levels of assistance from their state Medicaid programs.
What is the term that refers to evaluating for a healthcare service the appropriateness of its setting and its level of service?
What is the term that means evaluating, for a healthcare service, the appropriateness of its setting and its level of service? Utilization review. What is Medicare's term for a facility with a high percentage of low income patients? disproportionate share hospital.
Which government sponsored program is designed to provide managed care to the frail elderly population?
PACE provides comprehensive medical and social services to certain frail, elderly people (participants) still living in the community. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid.Dec 1, 2021
Where do evidence based clinical guidelines originate?
From where do evidence-based clinical guidelines originate? They have been systematically developed from scientific evidence and clinical expertise to answer clinical questions. Sources of these guidelines are the agency for Healthcare Research and Quality (AHRQ).
What is meant by the term technological imperative?
The concept that new technologies are inevitable and essential and that they must be developed and accepted for the good of society. This philosophy is naturally promoted by super geeks in high-tech companies.
What does tertiary diagnosis mean?
: highly specialized medical care usually over an extended period of time that involves advanced and complex procedures and treatments performed by medical specialists in state-of-the-art facilities — compare primary care, secondary care.
What is the term for an MCO that serves Medicare beneficiaries quizlet?
What is the term for an MCO that serves Medicare beneficiaries? Medicare Advantage. What term means a network of organizations that directly provides or arranges to provide a coordinated continuum of services to a defined population and takes accountability for the cost, quality, and outcomes of care?
What is the PACE program?
The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits.
What's the difference between Medicaid and Medicare?
Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.
When were clinical guidelines introduced?
In 2011, the Institute of Medicine (IOM) introduced eight standards for CPG development [16], which are similar to those promoted by the Guidelines International Network (G-I-N) [17] (Table 1). IOM [2] .Jan 21, 2016
For what reasons do MCO's survey their members for feedback?
List at least two reasons that MCOs survey their members for feedback. MCOs survey members to determine their satisfaction with services, perceptions of the plan's strengths and weaknesses, suggestions for improvement, and intentions regarding reenrolling in the plan.
Why is prescription management an important cost control quizlet?
Why is prescription management an important cost control? Prescription management is an important cost control because it increases the use of a formulary, a list of prescription drugs that health insurance will cover, to an inclusive approach to medications and medication administration.
What is Medicare medical insurance?
Medicare medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment , and some medical services that aren't covered by Part A. MEDICAL RECORDS INSTITUTE. An organization that promotes the development and acceptance of electronic health care record systems.
What is managed care organization?
Managed Care Organizations are entities that serve Medicare or Medicaid beneficiaries on a risk basis through a network of employed or affiliated providers. Stands for Managed Care Organization. The term generally includes HMOs, PPOs, and Point of Service plans.
What is a CMP plan?
Includes Health Maintenance Organizations (HMO), Competitive Medical Plans (CMP), and other plans that provide health services on a prepayment basis , which is based either on cost or risk, depending on the type of contract they have with Medicare. See also "Medicare+Choice". MANAGED CARE ORGANIZATION.
What is a health maintenance organization?
Is a health maintenance organization, an eligible organization with a contract under 1876 or a Medicare-Choice organization, a provider-sponsored organization, or any other private or public organization, which meets the requirements of 1902 (w) to provide comprehensive services. MANAGED CARE PAYMENT SUSPENSION.
What is a CMS approved system?
A CMS approved system that supports the operation of the Medicaid program. The MMIS includes the following types of sub-systems or files: recipient eligibility, Medicaid provider, claims processing, pricing, SURS, MARS, and potentially encounter processing. MEDICAID MCO.
What is Medicare for people 65 years old?
MEDICARE. The federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD).
What is a MedPAC?
MedPAC is directed to provide the Congress with advice and recommendations on policies affecting the Medicare program.