AOR POA & Release of Information

Acronyms

100

What does the acronym AOR stand for?

Appointment of Representative

200

What does HIPPA Stand For?

Health Insurance Portability and Accountability Act

300

What Does FCR stand for?

First Call Resolution

400

What Does CAHPS stand for?

Consumer Assessment of Healthcare Providers and Systems

500

What does COB Stand for ?

Coordination of Benefits

ENT Star Ratings

100

What does the Acronym HEDIS stand for?

Healthcare Effectiveness Data and Information Set

200

Star Rating consists of up to what number of unique quality measures

47

300

What agency calculates Star Rating Scores for each measure?

CMS

400

What are the Score Determination's Key Measures?

1. Hedis

2. CAHPS

3. CMS

4. HOS

5. Part D Measures

500

CMS Assesses all Medicare Advantage Plans through a _______Star Quality Rating Scorecard with ____ representing the lowest and ____ being the highest

CMS Assesses all Medicare Advantage Plans through a ___5____Star Quality Rating Scorecard with _1___ representing the lowest and __5__being the highest

What is Medicare?

100

What are the 4 parts of Medicare?

Part A, B, C & D

200

What Part of Medicare covers the same Parts of A & B but is offered as private insurers like Centene?

Part C

300

What part covers hospital care and related services?

Part A

400

What Part Covers Prescription Drugs?

Part D

500

What part covers doctor appointments and outpatient medical care?

Part B

CAHPS

100

This accreditation is widely recognized evidence based program dedicated to quality improvement and measurement

NCQA

200

What is Centene's Enterprises Goal Star Rating?

A minimum of 4 out of 5 stars

300

Who Impacts Our CAHPS Scores?  (Name at least 3)

Network, Sales, IT Analytics, Population Health, Operations Customer Service, Appeals & Pharmacy

400

How can you Improve CAHPS?

1. Member First 2. Build Rapport 3. Communicate Clearly 4. Build Trust 5. Exceed Expectations

500

When is the CAHPS Blackout Period for Medicare?

February through July

AOR, POA & Release of Info

100

When a member dies, only the person named in the member's will or appointed by stat law can deal with matters on the member's behalf is called

Executor or Administrator

200

A person named under a Living Will to act on behalf of a member

Healthcare Proxy

300

A court appointment of __________ or _________ of the person is a legal document issued by a court

Guardianship or Conservatorship

400

A legal instrument that grants another person the authority to act as a member's legal representative and to make binding financial and healthcare decisions on the member's behalf

Durable POA or Power of Attorney

500

What is another name for the AOR Form?

CMS 1696 Form for Medicare