1851078
| Question | Answer |
| Case Management | Process of eligibility determination and coordination of services for person receiving multiple healthcare services |
| Peer review organizations | Medicare-sponsored organizations that perform quality control, investigatory, patient education functions |
| Medically necessary | Physician-status provider determination that a healthcare intervention is required |
| Spend down | Process where person with potential Medicaid eligibility uses up assets to a certain level to gain eligibility for the program |
| Fee for service | Payment mechanisms for health care whereby provider is paid amount of money for each procedure performed |
| Beneficiary | Recipient of benefits from insurance contract |
| Capitation | Payment mechanism for health care where provider is paid a flat flee for each covered member in a health plan per month |
| Access | Ability to obtain a healthcare service when you need it |
| Prospective payment | Form of healthcare payment where providers are paid a set fee or rate prior to delivery of services |
| Dual eligibility | Persons who qualify for Medicare and Medicaid coverage |
| Benefit period | Length of time from day of admission to hospital to 60 days post-hospital or SNF discharge |
| Cost-based reimbursement | Retrospective method of healthcare financing whereby provider reports costs of providing care and is paid by an insurer |
| Medically needy eligibility | State option qualification for Medicaid based on demonstrated medical need or income level |
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