Medicare
Type of funding Medicare receives
What is federal funding?
Type of funding Medicaid receives
What is federal and state funding?
Each Medicare patient must be asked this series of questions at check in.
What is the MSPQ?
Electronic payor verification portal in EPIC designed to provide coverage details and alerts to possible errors.
What Is RTE?
Qualchoice, BCBS and Ambetter are examples of these types of plans.
What are Medicaid Expansion/AR Home/CAT 6 plans?
65 years old, disabled, ESRD
What qualifies a patient for Medicare services?
Most covered services require these unless their services are predetermined to be exempt or implied.
What is a Medicaid PCP referral?
Black Lung Benefits, Department of Veteran's Affairs, Worker's Comp, MVA, commercial coverage
Which payors listed on the MSPQ come first in the filing order before Medicare?
When RTE returns an alternate or additional payor response.
When will Access Staff need to update and correct an insurance.
A plan designed to fill in the gaps of Medicare coverage
What is a Medicare Supplement Plan?
In-patient hospital care, skilled nursing services, hospice care
Which services are covered by Medicare Part A?
Low income, pregnant, responsible for children 17 years or younger, disabled, or blind
What qualifies a patient for Medicaid?
The claim will be denied and will result in fines and employee termination.
What are some consequences for skipping the MSPQ?
Claims can be denied or cause a delay in billing. Patients can also recieve incorrect billing statements.
What happens when the RTE is not read?
Provider-led Arkansas Shared Savings Entity
What does PASSE stand for?
This 11 character alphanumeric identifier must use capital letters to return an accurate response.
What is MBI?
This should be marked in the documents section when a pregnant patient does not have a PCP assigned.
What is "service exempt"?
Missing Retirement Date, Inconsistent or Conflicting Information between MSPQ and Face Sheet, Not answering the # of employees
What are some common MSPQ errors?
"Medicare Secondary to GHP", "Plan Mismatch" , "Rejected".
What are some error responses from RTE?
A Medicaid Expansion Plan does not require this.
What is a Medicaid PCP referral?
When a private company manages a patient's Medicare plan.
What is a Medicare Advantage Plan?
Medicaid PCP Referrals are typically valid for this length of time.
What is 6 months?
How many employees does Company have to have in order for Medicare to be Primary?
19 or less for age and 99 or less for disable employees?
Will accept the answers 20/100
Access Coordinators will need to change ____ _______ when the alert states that an additional payor is detected.
What is changing the insurance coverage?
CareSource, Empower, AR Total Care, and Summit Community Care.
What are the PASSE plans?