Concepts

Question 1

QMB

Answer 1

Qualified Medicare Beneficiary
The Qualified Medicare Beneficiary (QMB) program provides Medicare coverage of Part A and Part B premiums and cost sharing to low-income Medicare beneficiaries. In 2017, 7.7 million people (more than one out of eight people with Medicare) were in the QMB program.

Question 2

Balance Billing (Medicare)

Answer 2

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.

Question 3

PEBB/SEBB

Answer 3

Public Employees Benefits Board / School Employees Benefits Board

Question 4

ETL

Answer 4

Extract/Transform/Load

Question 5

PHI

Answer 5

Protected Health Information

Question 6

VBP

Answer 6

Value-Based Purchasing

Question 7

OnPoint

Answer 7

Contracted to develop the APCD for HCA

Question 8

de minimis

Answer 8

No significance or not worthy of consideration

Question 9

DAN

Answer 9

Disposition Authority Number (Retention Policy)

Question 10

MOUD

Answer 10

Medications for Opioid Use Disorder

Question 11

FFS

Answer 11

Fee for Service (highest reimbursement for providers)

Question 12

FFP

Answer 12

Federal Financial Participation

Question 13

SNF

Answer 13

Skilled Nursing Facilities

Question 14

PMPY

Answer 14

Per-member-per-year

Question 15

NCBPs

Answer 15

Non-Claims-Based Payments

Question 16

NCPHI

Answer 16

Net Cost of Private Health Insurance

Question 17

THCE

Answer 17

Total Health Care Expenditures

Question 18

TME

Answer 18

Total Medical Expenditures / Total Medical Expense

Question 19

APM

Answer 19

Alternative Payment Methods

Question 20

PHE

Answer 20

Public Health Emergency

Question 21

BRG

Answer 21

Business Resource Group

Question 22

PCTM

Answer 22

Primary Care Transformation Model

Question 23

HRSN

Answer 23

Health-related social needs

Question 24

ADI

Answer 24

Area Deprivation Index

Question 25

SDOH

Answer 25

Social Determinants of Health

Question 26

RFA

Answer 26

Request for Application

Question 27

PCPCM

Answer 27

Person-centered Primary Care Measure

Question 28

FQFC

Answer 28

Federally Qualified Health Center (like Planned Parenthood?)

Question 29

DRG

Answer 29

Disease-Related Groups
Basically aggregated cases by CPT, ICD

Question 30

ICD

Answer 30

International Classification of Diseases

Question 31

CPT

Answer 31

Current Procedural Terminology

Question 32

TCOC

Answer 32

Total Cost of Care

Question 33

DEX

Answer 33

Disease Expenditure

Question 34

ACO

Answer 34

Accountable Care Organization

Question 35

Dual-Eligible

Answer 35

Eligible for both Medicare and Medicaid

Question 36

MMP

Answer 36

Medicare-Medicaid Plan

Question 37

Capitation

Answer 37

Bulk payments to providers based on a “per head” calculation rather than a per service. Drives incentives toward whole health of the patient.

Question 38

DSRIP

Answer 38

Delivery System Reform Incentive Payment program

Question 39

DY

Answer 39

Demonstration Year

Question 40

IGT

Answer 40

Intergovernmental Transfer

Question 41

IMC

Answer 41

Integrated Managed Care

Question 42

P4R

Answer 42

Pay-for-Reporting

Question 43

P4P

Answer 43

Pay-for-Performance

Question 44

LTSS

Answer 44

Long-term Services and Supports
[CMS program]

Question 45

DoN

Answer 45

Determination of Need
Essentially a permitting system for providers to clear building projects through government agencies

Question 46

MA Plans

Answer 46

Medicare Advantage Plans

Question 47

IMC

Answer 47

Integrated Managed Care

Question 48

DP

Answer 48

Decision Packages (changes in budgetary funding)

Question 49

EHB

Answer 49

Essential Health Benefits
Services mandated to be included by a HC plan as a part of ACA

Question 50

NPR

Answer 50

Net Patient Revenue

Question 51

GME

Answer 51

Graduate Medical Education
Term for Workforce development