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Mpje Study Guide > Part 3 > Flashcards

Part 3 Flashcards

1
Q

What is the NIH

A

National Institute of Health

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2
Q

What is the NIH for

A

Government agency for biomedical research

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3
Q

What department is the NIH under

A

Department of Health and Human Services

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4
Q

What does the NIH fund

A

Clinical trials through tax payer dollars

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5
Q

What is the Institute of Medicine responsible for

A

The to err is human report
1. Sheds light on health care errors
2. Puts blame on systems not individuals

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6
Q

What is AHQR

A

Agency for Health Care Quality and Research

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7
Q

What does AHQR create (SBEAA)

A

Improvements in health care by making it
1. Safer
2. Better
3. Equitable
4. Accessible
5. Affordable

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8
Q

What department is AHQR under

A

Department of Health and Human Services

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9
Q

What is the NQF

A

National Quality Forum

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10
Q

What does NQF focus on?

A

Health care system as a whole
(Whole NQF)

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11
Q

What does NQF create and support

A

Methods and training programs that save lives

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12
Q

What does NQF endorse

A

Healthcare standards and quality measures

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13
Q

What is CMS

A

Centers for Medicare and Medicaid

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14
Q

What department is CMS under

A

Department of Health and Human Services

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15
Q

What 3 health care programs does CMS administer

A
  1. Medicare
  2. Medicaid
  3. Health Insurance Marketplace
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16
Q

When do patients become eligible for medicare

A
  1. Age 65
  2. Disability
  3. ERSD - end stage renal disease
  4. ALS - Lou Gherigs
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17
Q

What does Medicare A cover

A
  1. Hospital Benefits
  2. Skilled nursing facility under certain circumstances
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18
Q

What 5 things does Medicare B cover

A

1.clinical and preventative care
2. DME
3. Nebulizer/diabetic testing supplies/drugs delivered by pumps
4. Most Vaccines
5. Drugs for end stage renal disease ESRD

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19
Q

Another name for Medicare part c

A

Medicare advantage plans

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20
Q

What does Medicare part c include

A

Both parts A and B

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21
Q

What are additional benefits that may fall under medicare part c

A
  1. Prescription drugs
  2. Vision
  3. Dental
22
Q

Explain Tiers of Medicare part D coverage

A

Tier 1 - little to no copay (generic drugs)
Tier 2 - preferred brand name drugs
Tier 3 - non preferred brand name drugs
Specialty tier -specialty drugs ie biologics

23
Q

Most vaccines are covered under part b what vaccine is covered under part d

A

Shingrix

24
Q

6 classes of drugs not covered by part D

A
  1. Benzodiazapines
  2. Otcs
  3. Barbiturates
    4.fertility
  4. Weighloss/weight gain
  5. Hair growth
25
Q

What 6 drug classes are protected under part d and must cover the majority or all of these classes

A
  1. Seizure drugs
  2. Antidepressants
  3. Antipsychotics
  4. Oncology
  5. HIV
  6. Immunosuppressants
26
Q

How long do Medicare records need to be kept

A

10 years

27
Q

What is Medigap

A

Private insurers that cover out of pocket costs not covered by Medicare (generally does not cover the donut hole)

28
Q

What does MTM stand for?

A

Medication Therapy Management

29
Q

What 3 things make a patient eligible for MTM through Medicare D

A
  1. Annual drug expense of x amount of dollars (usually 4 to 5 thousand)
  2. Min of 2 to 3 chronic diseases
  3. Min of 2-8 part d covered drugs
30
Q

Billing code for initial 15 minutes of a new patient

A

99605

31
Q

Billing code for the 1st 15 minutes of and established patient

A

99606

32
Q

Billing code for the next 15 minutes for both established or new patients

A

99607

33
Q

What to bill if met with an established patient for 45 minutes

A

Bill 1 unit of 99606 and 2 units of 99607

34
Q

What does CMR stand for

A

Comprehensive Medication Review

35
Q

CMR MTM must be person to person by one of which three methods

A
  1. Face to Face
  2. Telehealth
  3. Phone medication review
36
Q

What is the purpose of CMR

A
  1. Improve pts knowledge of medications
  2. Assess medication therapy (including otc rx and herbals)
  3. Identify problems
  4. Create a plan to fix those problems
37
Q

Recommended format for CMR documentation

A
  1. CL - Cover Letter
  2. MAP - Medication Action Plan
  3. PML - Personal Medication List
38
Q

How often can a CMR be billed

A

Annually

39
Q

Difference between a targeted medication review and a CMR

A

Less intensive
Down for a specific reason ie new new med is started

40
Q

How often can a targeted Medication Review be billed

A

Quarterly

41
Q

What is REMS

A

Risk Evaluation and Mitigation Strategy

42
Q

What is the goal or REMS

A

Ensure the benefit is greater than the risk

43
Q

Examples or REMS meds

A
  1. Accurate - I pledge
  2. Clozaril- online registry
44
Q

Drug sponsors develop REMS, who reviews and approves it

A

FDA

45
Q

Why must be given to patients of an REMS drug

A

REMS Medication Guide
Given in addition to standard patient education

46
Q

Before a REMS drug is assigned, what must be completed

A

A time table for assessment

47
Q

What is ETASU

A

Elements to Assure Safe Use

48
Q

What is ETASU part of

A

REMS program

49
Q

What is ETASU

A

Required tasks for health care professionals

50
Q

When does ETASU need to be completed

A

Prior to prescribing or dispensing

51
Q

Examples of ETASU

A
  1. Specialized training
  2. Drug to only be given in a certain setting
  3. Lab tests may need to be done prior to dispensing/prescribing

Mpje Study Guide (5 decks)

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