Healthcare Basics
HHS
Health and Human Services?
Types of Enrollment Period & Name
2
1. AEP
2. SEP
SNF
Skilled Nursing Facilities
NPI
National Provider Identifier
FFS stands for
Fee for service
Types of US Healthcare Plan
1. Government Plans
2. Commercial Pans
OOPE
Out of pocket Expenses
COB
Co-ordination of Benefits
Is NPI same as tax ID?
No
ACA stands for
Affordable Care Act
CMS
Medicare and Medicaid Services.
What is Accumulators
An accumulator is a running total of money you've paid towards your out-of-pocket max for covered services or deductible or plan maximum.
LEP
Late Enrollment Penalty
NPI number include how many digits?
10
What is the three pillars of Triple Aim Healthcare?
1. Improved Patient Experience
2. Reduced Cost
3. Improved Population Health
Types of Special Need Plans
1. DSNP
2. CSNP
3. ISNP
Qualifying Events
1. Marriage
2. New Born
3. Divorce
4. Death
DME
What is Durable Medical Equipment?
Can rendering provider and billing provider be same in a claim?
Yes
What is two primary functions of Regulators?
Implement laws
Enforce laws
Benefit Criteria for Government Plans
Medicare - 65+ , ESRD, Disabled.
Medicaid - Low Income People (BFLP), Pregnant women
How do we received the Member Enrollments?
1. Paper/Email
2. Online Enrollment
3. Paper Enrollment
4. 834 Through State Site
HIPAA
What is Health Insurance Portability and Accountability Act?
PCP also known as
Gatekeeper
What is the Timeline for Annual Enrollment Period?
October 15 to December 7