Across
- 3. Type of risk an ACO may take on which involves penalties as well as rewards.
- 4. Medicare's "Medical Insurance" component, which covers physician services and is financed by premiums and general revenues.
- 5. 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.
- 10. The health reform measure which focused on all components of the Iron Triangle of Health. (acronym)
- 11. The fraudulent practice of documenting irrelevant conditions to make a patient seem more complex for a higher DRG payment.
- 13. A continually updated list of medications and related products supported by current evidence-based medicine.
- 16. A type of health system that has a diverse network of facilities and providers under one umbrella. (acronym)
- 18. A restriction that indicates additional clinical information is needed before a plan will make a decision on covering a drug.
- 21. The outpatient prescription drug benefit component of Medicare, established in 2003.
- 23. A federal drug pricing program that allows qualifying clinics and hospitals treating low-income patients to buy outpatient drugs at a steep discount.
- 24. The most severe type of drug recall, used when a product could cause serious health problems or death.
- 26. The maximum ingredient cost that will be paid for a drug, forcing the pharmacy to find the least expensive generic. (acronym)
- 27. The role the Government has when creating and enacting health policy.
- 28. A joint federal-state, income-based welfare program for selected low-income populations.
- 30. An organization of providers (doctors, hospitals, etc.) who agree to take responsibility for the cost and quality of care for a large patient population.
- 31. The DHHS agency that oversees health systems and outcomes research.
- 32. The DHHS agency responsible for biomedical and health research and a major source of research funding. (acronym)
- 34. Medicare's "Hospital Insurance" component, which is financed by payroll taxes.
- 35. The Inflation Reduction Act, capped out of pocket spending for this product.
- 36. Branch of Government that includes members of Congress.
- 37. A reimbursement model that incorporates value-based payments, moving away from pure fee-for-service.
Down
- 1. The practice of persuading government branches to vote or act in ways that protect certain interests.
- 2. The formula used to determine the federal contribution to each State's Medicaid spending, based on average per capita income. (acronym)
- 6. The 2022 law that allows Medicare to negotiate drug prices and requires inflation rebates. (acronym)
- 7. Used in the physician payment system to identify the cost components linked to procedures.
- 8. A coding system used to classify patient complexity and determine prospective payment for inpatient hospital stays. (acronym)
- 9. The 2015 law that created new payment models for physicians, including the Merit-based Incentive Payment System. (acronym)
- 12. A mechanism that allows states to test new approaches and operate their Medicaid programs outside of normal federal rules.
- 14. The three components of the "Iron Triangle of Politics" are Interest Groups, Bureaucracy and __________.
- 15. A federal social insurance program primarily for people aged 65 or older and those with specific disabilities.
- 17. A review of prescribing, dispensing, and patient use of drugs which can be prospective (at time of dispensing) or retrospective. (acronym)
- 18. The Medicare Advantage program, which allows beneficiaries to enroll in private insurance plans as an alternative to Original Medicare.
- 19. The ACA provision that required citizens to have health insurance or pay a penalty.
- 20. The "list price" of a drug as determined by the manufacturer. (acronym)
- 21. An intermediary contracted by insurance companies to manage prescription claims, formularies, and negotiate rebates. (acronym)
- 22. One of the categories of APMs which identifies how reimbursements are made.
- 24. The coding system for clinician procedures and services.
- 25. In what phase of drug development and approval does post marketing monitoring occur?
- 29. When a physician agrees to accept the Medicare-approved amount as full payment for a service.
- 33. A formulary restriction that requires a patient to try a less costly medication before the prescribed one will be covered.