History & Other Things
True or False: Prior to MCOs, there was a two-party system of payment between patient and insurance company.
False
True or False: The primary goals of HMOs are to (1) limit costs and (2) promote quality case.
True
A federal law that protects clients’ personal health information and gives them rights concerning the release of such information
What is HIPPA Privacy Rule?
One who administers services to members of specific health plans at economical rates in exchange for patient referrals.
What is Provider?
True or False: Termination of care only occurs when the client is ready.
False
This Act was enacted by Congress in 1996. Health insurance companies, HMOs, and government health programs are required to follow its rules.
What is HIPAA?
Members of this plan do not need physician referral to seek services.
What is Preferred Provider Organization (PPO)?
A federal law outlining a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.
What is HIPPA Security Rule?
Protects counselors in the event that they are faced with a malpractice suit
What is Malpractice Insurance?
The monitoring of treatment need, suitability of treatment intervention and treatment effectiveness.
A federal law that provides individuals with mental health and substance use coverage parity with benefit limitations under their medical coverage
What is The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)?
What is Point of Service (POS) Plan?
What is Written Consent?
The fee schedule listing the fees that are reimbursed for different service codes. The fees paid are dependent upon the MCO.
What is Current Procedural Terminology (CPT) Codes?
True or False: If an MCO will not authorize a client for additional sessions, the CMHC can take no further action.
False
If you needed eggs, would you walk into the market and take them without paying if you had a good relationship with the owner?
Addresses mental health issues, wellness, substance abuse, or any difficulties that might affect work performance.
What is Employee Assistance Program (EAP)?
True or False: HIPAA only protects the transfer of client records.
False
True or False: Once contracted with an MCO clinician contracts do not have to be renewed.
False
This document outlines the content of the session.
What is SOAP Notes?
Under these arrangements, clinical mental health counselors may compensate for reduced fees for services by seeing more clients which reduces the time available to discuss clients’ problems, explore treatment options, and maintain meaningful relationships.
What is Preferred Provide Arrangements?
One who administers, schedules, and approves all aspects of the patient’s medical care including mental health care.
What is Primary Care Physician (PCP)?
The thing that differentiates HIPPA rules from ACA Ethical Standards.
What is Federal Mandates?
The number created by the Centers for Medicaid & Medicare Services for those covered entities that transmit electronic transactions.
What is National Provider Identifier?
Your insurance reimbursement was previously denied due to an uncovered diagnostic code. Upon further evaluation of the clients symptoms and treatment plan you provide a secondary diagnostic code that is covered by the insurance company.
Is this ethical? Why or Why Not?
Yes!