What are
Pregnancy Management
Case Management
Behavioral Health
NICU Case Management
Special Needs
Regulatory
Short Term Case Management
Care Coordination
Disease Management
Long Term Services & Supports?
100
A very important DME item for a CHF member to have in the home.
What is a "scale"?
100
3 of the requirements for a case to be in the MEI
1. Group 3 or 2
2. Type in “02CM” or “Case/Care Management”
3. Days Open at least 90
4. No errors in Phase I of CMRT
5. Open at some point in 2011
100
The LIPA cut off for Group 3
What is 8?
200
These diagnostic categories on the CI3 represent the major clinical cost drivers for the member.
What is a "disease band" or "disease cohort"?
200
The abbreviation for this is CMRT
What is case management reconcilliation tool
200
The important vital sign you need to know about a CHF member to monitor progress after discharge.
What is "Dry Weight"
not "discharge weight"?
200
The health care costs of the member used to calculate the 2011 expenses for a member in the MEI
What are all health care costs?
200
A diagnostic
classification system that Medicaid programs can use to make health-based
capitated payments on which the CI3 predictive logic is based
What is "Chronic Illness & Disability Payment System (CDPS)"?
300
3, 2, 1, 0
What are the 4 group numbers?
300
The name of the new OB high risk screening tool
What is STORK SCORE?
300
The most common acute admitting diagnoses across all of AMERIGROUP Plans
What is "Schizophrenia"?
300
The period of time after closing a case, that the case remains in the MEI
What is 90 days?
300
At risk population for case management
What is the number in a population, like G3, G2, or BH or pregnancy that could be eligible for case management?
400
Abbreviated as LIPA
What is "likelihood of inpatient admission"?
400
3 of the most common errors on CMRT
What are?
all cases must have a case type
all cases must have a primary user
case type must agree with recommended type
closed cases must have an end date
open cases must be managed by current AGP staff
400
This controversial drug can really help reduce recurrent premature birth.
What is 17-P?
400
The most likely way to reach and sustain a high cost savings in case management
What is prevent admissions and readmissions?
400
The regression to the mean amount that is taken off of 2011 savings in the MEI
What is 20%?
500
4 disease bands
What are
DISEASE COHORT
HEMATOLOGIC
RENAL
CARDIOVASCULAR
SKIN
PULMONARY
Substance Abuse
DIABETES
AIDS_HIV
PSYCHIATRIC
Central Nervous System
SKELETAL
METABOLIC
Developmental Delay?
500
the correct case type for a group 3 member with sickle cell disease, substance abuse, frequent hospitalizations, and a positive urine pregnancy test in the ED yesterday
What is pregnancy management?
500
Probably the most important post discharge service to prevent a readmission
What is a provider or PCP follow up appointment within 7 days of discharge?
500
The members whose 2010 costs serve as the baseline for the costs tracked in 2011
Who are the members themselves, or the same members as in the 2011 MEI?
500
A slang term developed to indicate what happens to the probablility of an admission on a high cost member whose admissions fall way off while in case management.