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Mpje Study Guide > Part 3 > Flashcards

Part 3 Flashcards

(51 cards)

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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

Study These Flashcards
A
  1. Prescription drugs
  2. Vision
  3. Dental
22
Q

Explain Tiers of Medicare part D coverage

Study These Flashcards
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

24
Q

6 classes of drugs not covered by part D

Study These Flashcards
A
  1. Benzodiazapines
  2. Otcs
  3. Barbiturates
    4.fertility
  4. Weighloss/weight gain
  5. Hair growth
25
What 6 drug classes are protected under part d and must cover the majority or all of these classes
1. Seizure drugs 2. Antidepressants 3. Antipsychotics 4. Oncology 5. HIV 6. Immunosuppressants
26
How long do Medicare records need to be kept
10 years
27
What is Medigap
Private insurers that cover out of pocket costs not covered by Medicare (generally does not cover the donut hole)
28
What does MTM stand for?
Medication Therapy Management
29
What 3 things make a patient eligible for MTM through Medicare D
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
Billing code for initial 15 minutes of a new patient
99605
31
Billing code for the 1st 15 minutes of and established patient
99606
32
Billing code for the next 15 minutes for both established or new patients
99607
33
What to bill if met with an established patient for 45 minutes
Bill 1 unit of 99606 and 2 units of 99607
34
What does CMR stand for
Comprehensive Medication Review
35
CMR MTM must be person to person by one of which three methods
1. Face to Face 2. Telehealth 3. Phone medication review
36
What is the purpose of CMR
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
Recommended format for CMR documentation
1. CL - Cover Letter 2. MAP - Medication Action Plan 3. PML - Personal Medication List
38
How often can a CMR be billed
Annually
39
Difference between a targeted medication review and a CMR
Less intensive Down for a specific reason ie new new med is started
40
How often can a targeted Medication Review be billed
Quarterly
41
What is REMS
Risk Evaluation and Mitigation Strategy
42
What is the goal or REMS
Ensure the benefit is greater than the risk
43
Examples or REMS meds
1. Accurate - I pledge 2. Clozaril- online registry
44
Drug sponsors develop REMS, who reviews and approves it
FDA
45
Why must be given to patients of an REMS drug
REMS Medication Guide Given in addition to standard patient education
46
Before a REMS drug is assigned, what must be completed
A time table for assessment
47
What is ETASU
Elements to Assure Safe Use
48
What is ETASU part of
REMS program
49
What is ETASU
Required tasks for health care professionals
50
When does ETASU need to be completed
Prior to prescribing or dispensing
51
Examples of ETASU
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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