Exam 2 Review Spring 2026

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Across
  1. 2. The term for how Original Medicare measures the use of hospital services; it begins on admission and ends after 60 consecutive days without inpatient care.
  2. 3. The outpatient prescription drug benefit component of Medicare, established in 2003.
  3. 6. A federal social insurance program primarily for people aged 65 or older and those with specific disabilities.
  4. 12. A continually updated list of medications and related products supported by current evidence-based medicine.
  5. 13. A joint federal-state, income-based welfare program for selected low-income populations.
  6. 15. The maximum ingredient cost that will be paid for a drug, forcing the pharmacy to find the least expensive generic. (acronym)
  7. 16. The formula used to determine the federal contribution to each State's Medicaid spending, based on average per capita income. (acronym)
  8. 17. A coding system used to classify patient complexity and determine prospective payment for inpatient hospital stays. (acronym)
  9. 19. In what phase of drug development and approval does post marketing monitoring occur?
  10. 21. When a physician agrees to accept the Medicare-approved amount as full payment for a service.
  11. 22. The most severe type of drug recall, used when a product could cause serious health problems or death.
  12. 24. Medicare's "Hospital Insurance" component, which is financed by payroll taxes.
  13. 25. A review of prescribing, dispensing, and patient use of drugs which can be prospective (at time of dispensing) or retrospective. (acronym)
  14. 27. Used in the physician payment system to identify the cost components linked to procedures.
  15. 29. A federal drug pricing program that allows qualifying clinics and hospitals treating low-income patients to buy outpatient drugs at a steep discount.
  16. 31. The 2015 law that created new payment models for physicians, including the Merit-based Incentive Payment System. (acronym)
Down
  1. 1. A reimbursement model that incorporates value-based payments, moving away from pure fee-for-service.
  2. 4. Type of risk an ACO may take on which involves penalties as well as rewards.
  3. 5. The coding system for clinician procedures and services.
  4. 7. An organization of providers (doctors, hospitals, etc.) who agree to take responsibility for the cost and quality of care for a large patient population.
  5. 8. The Inflation Reduction Act, capped out of pocket spending for this product.
  6. 9. One of the categories of APMs which identifies how reimbursements are made.
  7. 10. An intermediary contracted by insurance companies to manage prescription claims, formularies, and negotiate rebates. (acronym)
  8. 11. A restriction that indicates additional clinical information is needed before a plan will make a decision on covering a drug.
  9. 14. A mechanism that allows states to test new approaches and operate their Medicaid programs outside of normal federal rules.
  10. 18. A type of health system that has a diverse network of facilities and providers under one umbrella. (acronym)
  11. 20. The fraudulent practice of documenting irrelevant conditions to make a patient seem more complex for a higher DRG payment.
  12. 23. A formulary restriction that requires a patient to try a less costly medication before the prescribed one will be covered.
  13. 26. Medicare's "Medical Insurance" component, which covers physician services and is financed by premiums and general revenues.
  14. 28. The "list price" of a drug as determined by the manufacturer. (acronym)
  15. 30. The Medicare Advantage program, which allows beneficiaries to enroll in private insurance plans as an alternative to Original Medicare.