Hot Topics Flashcards
CPT: Category I
- What list are they found in?
- What are they arranged by?
- How many digits? And #s, alpha, or both?
- Tabular List
- Arranged by sections
- 5-digit, numeric
CPT: Category II
- What are these used for?
- Are these used as part of the insurance billing process?
- What letter is the 5th digit?
- Performance measure
- No
- F
CPT: Category III
- Is this a permanent or temp code?
- What are these used for?
- Have these been added to the Tabular List?
- What letter is the 5th digit?
- Temporary
- Emerging and new tech, services, and procedures
- No
- T
HCPCS: Level I
- Alpha or numeric?
- What comprises Level I?
- What do these codes identify?
- 5-digit numeric code
- CPT (Current Procedural Terminology)
- Medical services and procedures by physicians and other health care professionals
HCPCS: Level II
- What does this include?
- Alpha or numeric?
- Products, supplies, and services not included in CPT - ambulance and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) used outside physician’s office
- Alpha-numeric - single alpha letter followed by 4 #s
What are the 3 types of Managed Care Organizations (MCOs)?
- Health maintenance organication (HMO)
- Preferred provider organization (PPO)
- Exclusive provider organization (EPO)
HMO: What are they required to include in health plan?
Preventative care
HMO: What is the goal?
Reduce the cost of while still providing quality health care
HMO: High or low monthly premiums?
Low
HMO: What are patients required to select?
PCP: Primary Care Provider
- Acts as a gatekeeper to more specialized care
HMO: Are precertifications and preauthorizations always required for hospital admissions, outpatient procedures, and treatments?
Yes!
PPO: Do PPOs contract with a group of providers?
Yes
PPO: What type of fee plan does a PPO use?
Fee for service; preferred by providers
EPO: What features does an EPO include?
Both from HMO and PPO
EPO: Are you required to select a PCP?
Nope!
TRICARE: Who does this serve?
- Uniformed service members
- Retired service members
- Families of the above
CHAMPVA: Who does this serve?
- Families of veterans who were permanently disabled or killed in line of duty
Maslow: What are the bottom four levels?
- Deficiencies
- Coping behaviors
Maslow: What are the top four levels?
- Growth
- Brings long-lasting happiness
Maslow: Put the eight levels in order from bottom to top
- Esteem needs
- Aesthetic needs
- Love and belongingness needs
- Cognitive needs
- Transcendence needs
- Physiological needs
- Safety needs
- Self-actualization needs
Starting at the bottom and going up…
- Physiological needs
- Safety needs
- Love and belongingness needs
- Esteem needs
- Cognitive needs
- Aesthetic needs
- Self-actualization needs
- Transcendence needs
Maslow: Describe physiological needs
- Air, food, drink, shelter, warmth, oxygen, sleep, etc
- Needed for survival
Maslow: Describe safety needs
- Protection of elements, security, order, law, stability, etc
Maslow: Describe love + belongingness needs
- Friendhip, intimacy, acceptance in a group, receiving and giving affection
- Need to be accepted by others
Maslow: Describe esteem needs
- Self-esteem, achievement, mastery of skills, independence, status, pestige, etc
Maslow: Describe cognitive needs
- Knowledge, curiosity, understanding, and exploration
Maslow: Describe aesthetic needs
- Search for beauty, balance, symmetry, form, etc