ch25 Flashcards
(21 cards)
MHPA
it is a federal law that affects large self funded group health plans and large employment related group health plans. (mental health parity act of 1996).
HIPAA
health insurance portability and accessibility act- it includes rules governing the use of standards and administrative code sets for the electronic exchange of healthcare data- specifies the types of measures required to protect the security and privacy of personally identifiable health care info.
NPI
national provider identifier- the adoption of standard unique identifiers for health care providers and health plans
CMS
centers for medicare and medicaid services- the federal agency that administers the medicare program and works with the states to run medicaid and the state childrens health insurance programs
HCPCS
healthcare common procedure coding system - helps pay for DME
ICD-10
international classification of diseases - 10th revision - standardized diagnosis coding system for the US
DSM
diagnostic and statistical manual of mental disorders- groups mental health disorders into 16 major diagnostic classes
ICF
international classification of functioning, disability and health
Who is Medicare for and when did it start?
1965- part of the social security act amendments, health care coverage for people older than 65, people with disabilities, and people with end stage renal disease.
What is Medicare Physician Fee Schedule (MPFS) and why might I need to know this as a business owner?
medicare pays a provider 80% of the fee schedule amount after the beneficiary has paid a yearly deductible for all medicare part B services.
medicare Part A
hospital insurance program
medicare B
supplementary medical insurance program (traditional/original medicare program)
medicare C
commonly referred to as medicare advantage plans
medicare D
prescription drug program
What is Medigap?
the traditional medicare plan does not pay 100% of the cost of most services but requires that the beneficiary be responsible for deductible and coinsurance amounts
What kind of insurance do federal employees have (US senators, park rangers at national park, etc) and why is this important?
covers 8 million active and retired federal employees, offers more than 350 health plans- Federal Employees Health Benefits Program (FEHBP)
Who is Tricare for?-
major component of the MHS serving active duty service members, national guard, and reserve members, retirees, their families, survivors and certain former spuses
What is PACE?
the program of all inclusive care for the elderly, they serve participants who are ages 55 or older, are eligible for both medicare and medicaid, need a nursing facility level of care, and live in a pace organization service area.
Who is Medicaid for?
services are provided to people with limited incomes and resources who also meet specific additional state requirements
What did the Omnibus Reconciliation Act of 1987 do for nursing homes?
- it required nursing homes to use a uniform resident capital assessment, capital instrument, for all residents.
When did congress approve school systems to begin charging Medicaid for services provided?
1988
