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