Cm Ccp Board 1 Jeopardy Template

Definitions	Acronyms	Process	M&M	Reimbursement
100 What is Case Management The dynamic and systematic collaborative approach to providing and coordinating health care services to a defined population.	100 What is Case Management Adherence Guide - Evidence based assessment tools based on specific diseases CMAG	100 What is Assess, plan, implement/intervention, monitor/evaluation Four Stages of Case Management	100 What is Part A Part of Medicare that covers skilled nursing facility care.	100 What is case rate reimbursement A specific reimbursement paid based on an agreement reached between the payer and the healthcare providers. This payment covers the cost of a specific group of treatments and services.
200 What is Standards of Care Parameters to measure the quality of healthcare	200 What is Preferred provider organization's, are large group of medical providers providing medical services on A negotiated or discounted fee for service schedule. Employees pay a higher coinsurance if they receive services outside the PPO. PPO	200 What is the contemplative stage of learning The stage of learning when a person is thinking about making changes but not implementing any actions.	200 What is Part B Part of Medicare that covers durable medical equipment	200 What is bundled reimbursement Care reimbursed according to expected cost for a clinical episode of care
300 What are Clinical Guidelines Statements to help make decisions about health specific circumstances.	300 What is Exclusive provider organizations, use a network of contracted positions who care for enrollees at a discounted rate. Enrollees are not reimbursed for care received from a provider not part of EPO. EPO	300 What is discharge planning Should begin on admission	300 What is "People over 65 years old and receiving or eligible for benefits through the Social Security or a railroad retirement system. People who don't have a spouse covered by Medicare covered government employment Disabled people once they are on Social Security disability benefits for 24 months and have completed the five month waiting period for a total of 29 months Diagnosed with permanent kidney failure or end-stage renal disease meaning they are on dialysis or require a transplant Social Security or railroad retirement benefits must also be met and they have a three month waiting period before benefits begin." Medicare Eligibility	300 What is Prospective Payment System System of payment which health care services (eg. SNF, hospital) get reimbursed through pre-determined reimbursement rates based on Dx at time of admission
400 What is a Clinical Pathway Structured multi-disciplined plan of care to support clinical guidelines and protocol to improve continuity and coordination.	400 What is Point of service, plans are a combination of PPO and HMO plan using contracted network of providers and a primary care physician as a gatekeeper to control specific specialty referrals. Reimbursement for care provided by out of network physicians are subject to higher deductibles and coinsurance amount. POS	400 What is three weeks The standard length of stay for inpatient rehab	400 What is 60 days Benefit period for Medicare	400 What is reimbursed through DRG (diagnosis related groups) Reimbursement process for PPOs
500 What is a Predictive Screening Tool Shows what may happen to a specific population.	500 What is Old age survivor and disability insurance program which is the centerpiece of social security act. It provides hospital insurance to elderly and supplementary medical insurance for other medical costs. OSADI	500 What is talk with the individual about treatment plans and adherence The best way to assess a patient's compliance with treatment	500 What is Medigap Private insurance that helps pay for gaps that Medicare does not cover.	500 What is reimbursement process for HMOs Capitation: A fixed amount of money per member per month paid to a care provider for covered services rather than fee for service

CM CCP Board 1

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