Medicare Knowledge
Covers 80% of healthcare costs
What is Traditional Medicare?
Exercise Programs, Post discharge meals, etc.
What are value added benefits under some MA Plans?
Deemed private (non-governmental) health insurance
What is commercial health insurance?
True or False
We can document more than 4 days from contact?
False.
Our policy is that all documentation must be complete within 3 business days.
Where you will find our shared documents
What is the shared Gdrive?
The part of medicare that covers most prescription meds
What is Part D?
True or False:
I can use any doctor with my Medicare Advantage Plan
False.
For the visit to be covered, you must use a contracted physician within that plan's network.
60%
What is the amount of pediatric members in our commercial contract?
Focused Needs Assessment (FNA)
What is the assessment to be completed for all non-complex members?
Connects
What is the name of our internal Intranet?
Part A, Part B, Part C, Part D
What are the 4 parts of Medicare
True or False:
Every Medicare Advantage plan covers the same drugs
FALSE:
Each Medicare Advantage plan has their own formulary and limits when it comes to drug coverage.
How most people get commercial insurance
What is through their employer?
29 days
What is the time-frame in which all documentation must be completed for complex cases?
Where I enter PTO or my time worked
What is ADP?
Medicare Part that covers inpatient stays that is free for most
What is Part A?
Getting approval before receiving a service or supply
What is prior authorization?
COBRA
What is a method of continuation of health coverage after one leaves a job? The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances
Virtual Health (Helios)
What is the name of our CM documentation platform?
Bonus: What CM platform does the APCM program document in?
Where can I submit expenses for reimbursement
What is Concur
True or False:
I can use any doctor under Traditional Medicare without requiring a pre-authorization
False
While Traditional Medicare does NOT require pre-authorization to see a physician; any doctor you see must accept Traditional Medicare.
Subset of our Medicaid practices in our CIN
Who is contracted with our MA plans?
What is Blue Connect
Portal for members to use to obtain information on their BCBS plan, participating providers, and claims data
Location of documentation for all Action items
What is the care plan?
What is the Team Huddle
Meetings that provide education on programmatic changes and organizational updates