Specified Low-income Medicare Beneficiary – A Medicaid program that pays for Medicare Part B premiums for individuals who have Medicare Part A, a low monthly income, and limited resources.
Further reading
Medicaid Acronym of the Day – SLMB
Category: MAOTD (Medicaid Acronym of the Day)
Medicaid Acronym of the Day – QIO
Quality Improvement Organization – The QIO Program, one of the largest federal programs dedicated to improving health quality for Medicare beneficiaries, is an integral part of the U.S. Department of Health and Human (HHS) Services’ National Quality Strategy for providing better care and better health at lower cost. By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. Based on this statutory charge, and CMS’s program experience, CMS identifies the core functions of the QIO Program as:
Improving quality of care for beneficiaries;
Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting; and
Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.
Further reading
Medicaid Acronym of the Day – EMTALA
The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate.
Further reading
https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/
Medicaid Acronym of the Day – CAHPS
Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. The acronym “CAHPS” is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
Further reading
https://www.ahrq.gov/cahps/about-cahps/index.html
Medicaid Acronym of the Day – ABN
Advance Beneficiary Notice – The ABN is a written notice you must issue to a Fee-For-Service beneficiary before furnishing items or services that are usually covered by Medicare but are not expected to be paid in a specific instance for certain reasons, such as lack of medical necessity. The ABN allows the beneficiary to make an informed decision about whether to get the item or service that may not be covered and accept financial responsibility if Medicare does not pay. If the beneficiary does not get written notice when it is required, he or she may not be held financially liable if Medicare denies payment, and you may be financially liable if Medicare does not pay. The ABN is used for Medicare Part B (outpatient) and Part A (limited to hospice, Home Health Agencies, and Religious Nonmedical Health Care Institutions only) items and services.
Further reading
https://www.medicare.gov/claims-and-appeals/medicare-rights/abn/advance-notice-of-noncoverage.html
Medicaid Acronym of the Day – AAPC
American Association of Professional Coders – a professional association for people working in specific areas of administration within healthcare businesses in the United States.[5] AAPC is one of a number of providers who offer services such as certification and training to medical coders,[4] medical billers, auditors, compliance managers, and practice managers in the United States. Currently, AAPC has over 155,000 worldwide members,[6] of which nearly 108,000 are certified.
Further reading
Medicaid Acronym of the Day – COL
Colorectal Cancer Screening – The percentage of members 50–75 years of age who had appropriate screening for colorectal cancer.
Further reading
Medicaid Acronym of the Day – CDC7
Comprehensive Diabetes Care Medical Attention for Nephropathy.
Further reading
Medicaid Acronym of the Day – CDC4
Comprehensive Diabetes Care Eye Exam – Eye exam (retinal) performed.
Further reading
https://hmsa.com/portal/provider/PRC_Guide_Comprehensive_Diabetes_Care_Eye_Exam.pdf
Medicaid Acronym of the Day – CDC1
Comprehensive Diabetes Care A1c Testing – The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following:
• Hemoglobin A1c (HbA1c) testing.
• HbA1c poor control (>9.0%).
• HbA1c control (<8.0%).
Further reading