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Flashcards in Developing Clinical Practice Deck (23):
1

implementation costs

one time fixed costs; capital expenditures

2

operating costs

personnel cost/what's calculated for staffing needs

3

seven P's

product, price, place, promotion, people, packaging, process

4

four I's

intangible, inseparability, inconsistency, inventory

5

incident to billing

services are defined as services or supplies furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness

6

quick and manageable process for all groups

plan, do, study, act (PDSA)

7

AHRQ

national strategy for quality improvement in health care; agency healthcare research quality

8

National Quality clearinghouse

public resource for evidence based quality measures

9

NCQA

national committee for quality assurance; developed the HEDIS (healthcare effectiveness data and information set)

10

physician quality reporting system

mandatory program with attached financial incentives and disincentives for eligible B providers, where providers must choose at least 9 measures

11

exceptions where pharmacists can bill to services

immunizations, diabetes education, MTM

12

digit cards start with __ that relate to physician visits in ambulatory setting

99 (where ending number increases as visit gets more complex)

13

official standard form used by individual health care providers

1500

14

forms used by facilities or institutions when submitting bills

CMS-1450

15

pharmacists can't bill beyond ____

99211

16

MTM can/cannot be billed under incident to billing

cannot

17

G108, G109

Diabetes education codes, 8- individual visits 9- group visits

18

G0402, G438, G439

02: initial preventative physical examination, 438, initial AWV, 439: subsequent visits

19

99496; 99495

transitional care management; 96- w/n 7 days, 95- w/in 14 days

20

99490 CCM requires

20 minutes of qualified staff time

21

MACRA

Medicare access and chip reauthorization act; changes way Medicare pays clinicians under Med B and establishes nw payment framework; streamlines MIPS and APMS

22

MIPS

merit based incentive payment system

23

APM

advanced alternative payment models