Acronyms
Appointment of Representative
What does the Acronym HEDIS stand for?
Healthcare Effectiveness Data and Information Set
What are the 4 parts of Medicare?
This accreditation is widely recognized evidence based program dedicated to quality improvement and measurement
NCQA
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
What does HIPPA Stand For?
Health Insurance Portability and Accountability Act
Star Rating consists of up to what number of unique quality measures
47
What Part of Medicare covers the same Parts of A & B but is offered as private insurers like Centene?
Part C
What is Centene's Enterprises Goal Star Rating?
A minimum of 4 out of 5 stars
A person named under a Living Will to act on behalf of a member
Healthcare Proxy
What Does FCR stand for?
First Call Resolution
What agency calculates Star Rating Scores for each measure?
CMS
What part covers hospital care and related services?
Part A
Who Impacts Our CAHPS Scores? (Name at least 3)
Network, Sales, IT Analytics, Population Health, Operations Customer Service, Appeals & Pharmacy
A court appointment of __________ or _________ of the person is a legal document issued by a court
Guardianship or Conservatorship
What Does CAHPS stand for?
Consumer Assessment of Healthcare Providers and Systems
What are the Score Determination's Key Measures?
1. Hedis
2. CAHPS
3. CMS
4. HOS
5. Part D Measures
What Part Covers Prescription Drugs?
Part D
How can you Improve CAHPS?
1. Member First 2. Build Rapport 3. Communicate Clearly 4. Build Trust 5. Exceed Expectations
Durable POA or Power of Attorney
What does COB Stand for ?
Coordination of Benefits
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 part covers doctor appointments and outpatient medical care?
Part B
When is the CAHPS Blackout Period for Medicare?
February through July
What is another name for the AOR Form?
CMS 1696 Form for Medicare