Shared Flashcard Set

Details

4A071
7-Level CDC's
152
Health Care
Professional
12/14/2009

Additional Health Care Flashcards

 


 

Cards

Term
How often is the P2R2 access metric updated by the MTF point of contact?
Definition
Monthly
Term
What is the purpose of the CHCS ATC (Access to Care) summary report?
Definition
Calculates the time between the appointment request and when the patient is seen
Term
Which tool allows each MTF to compare their performance to other peer facilities?
Definition
TRICARE operations center (TOC)
Term
Name three ways the BDQAS biometric data is used
Definition
(1)Supports population health management decisions.(2)Provides quantitive justification for resource decisions. (3)Support managed care contract negotiations, business cost analysis, and the bid price adjustment.
Term
How does the AFMS (Air Force Medical Service) and the MTF's improve biometric data quality?
Definition
The BDQAS web-site provides sites with the ability to monitor their timeliness and completeness in coding and file transmissions
Term
Explain why each MTF uses the P2R2 access metric
Definition
Each MTF uses P2R2 to record and manage monthly access to care performance in relation to established standards
Term
What serves as an MTF-level management tool that evaluates scheduling adequacy and sufficiency of an MTF's schedule and/or templates in support of TRICARE Prime access standards?
Definition
The TAT (Template Analysis Tool)
Term
which report provides a preview of the abailability of appointments by appointment type and by provider within a clinic on a given date and time?
Definition
Next abailable appointment report
Term
Who generates the CHCS access to care summary reports weekly?
Definition
TOC (Tricare Operations Center)
Term
What is the benefit of the appointment utilization report?
Definition
The benefit of this report is to see if appointment type slots are being created for special appointment types but not being used (unbooked appointments).
Term
Which CHCS report provides the number of facility appointment cancellations by reason for each clinic and provider?
Definition
Facility cancellation statistical report
Term
Which is not a benefit of using the OA (Open Access) model for booking appointment?
Definition
Increased patient no-show and cancellation rates
Term
What model allows MTF's to accommodate more patients without working longer days and improve the educational content of their patient encounters?
Definition
Group visits, such as drop-in group medical appointment (DIGMA)
Term
Who uses the TAT (Template Analysis Tool) to evaluate scheduling adequacy and sufficiency of a MTF's schedules and templates in support of Tricare Prime Access stanadards?
Definition
MTF
Term
Which CHCS report provides a preview of the availability of appointments by appointment type and by provider with a clinic on a given date and time?
Definition
Next available appointment report
Term
Name the CHCS model utilized for all appointment booking.
Definition
Managed Care Program (MCP)
Term
Tools, such as the P2R2 access metric, the CHCS ATC (Access to Care) summary reports, and the MTF TAT (Template Analysis Tool), and appointment type utilization reports are available to assist MTF personnel do what?
Definition
Are available to assist MTF personnel manage access to care
Term
What tool provides a user-friendly interface that allows navigation and ease of viewing appointment supply and demand by all clinics in an MTF?
Definition
Access improvement Module (AIM)
Term
What is the name of the site on the web where you can locate the tools to run and utilize reports?
Definition
Tricare Operations Center (TOC)
Term
What tool was developed to ease the burden of analyzing data from the many reports available in the CHCS?
Definition
Balanced Scorecard
Term
What are the standards for the four categories of beneficiaries - Urgent Care, Routine Appointment, and Wellness Health promotion?
Definition
Urgent Care: 24 hours, Routine appointment: 7 days, Routine speciality care: 28 days, Wellness health promotion: 28 days.
Term
What is the appropriate access-to-care standard for wellness and health promotions appointments?
Definition
28 days
Term
What are some of the specific responsibilities of the Tricare Regional Offices?
Definition
(1)Ensuring network quality and adequacy to include provider issues (2)Monitoring customer satisfaction outcomes. Managing TRO customer service issues. Coordinating, appointing and referral management policies. (3)Addressing enrollment issues. Managing contract and fiscal management functions.
Term
Explain the most recent changes to the Tricare Program.
Definition
Reducing the number of stateside health care service contracts from seven to three, and the number of stateside Tricare regions was reduced from (11) to (3)
Term
Who represents the new management organization for managing regional contractors and overseeing an intergrated health care delivery system in the US?
Definition
Tricare regional office (TRO)
Term
Who monitors MTF performance in accordance with the business plans and communicates with the MTF commanders?
Definition
The regional director
Term
Name each of the three Tricare regional offices and the regional contractor for each
Definition
North-Health Net, South-Humana, West-TriWest
Term
Name five incentives that the AFMS gives to each MCS (Managed care support) contractor for top performance
Definition
(1)Quality medical outcomes (2) telephone access (3)cost control (4)claim payments (5)beneficiary, MTF commander, regional director satisfaction.
Term
Where do MCS (Managed Care Support) contractors and TRO (Tricare Regional Office) receive overall guidance?
Definition
TMA (Tricare management activity)
Term
Name the specific responsibilities of the TRO (Tricare Regional Office) ACO (Administrative Contracting Officer)
Definition
(1)Assisting the TRO in defining new requirements that necessitate contract modification (2) Performing technical evaluations of change order proposals (3)Assisting in resolving contractual issues (4)Evaluating contractor proposed resource sharing agreements (5)Proposing resource sharing agreements to contractor
Term
Who does the MCS (Managed Care Support) contractor work with to manage Tricare at a regional level?
Definition
With the TRO's (Tricare Regional Offices)
Term
Who performs annual BID price adjustments?
Definition
Contracting Officer's Representative (COR)
Term
What is the purpose of contacts?
Definition
To effectively monitor and evaluate the Tricare MCSC (Managed Care Support Care) performance, and to advise and resolve problem situations, to coordinate staff proposals for decision making, to advise the commander and department/division Chiefs on matters pertaining to contract execution.
Term
The COTR (Contracting officer technical representative) will prepare minutes for all meetings with whom?
Definition
With the contractor or contract personnel
Term
The COTR (Contracting officer technical representative) assists what element by certifying contractor invoices by cross-matching with time sheets, schedules, and weekly reports?
Definition
Business analysis element
Term
As a COTR (Contracting Officer Technical Representative) you should be able to perform your job independently. What would be a situation that might require your supervisor's help or input?
Definition
Most unusual or controversial situations
Term
As a COTR (Contracting Officer Technical Representative) you will have to stay within guidelines. Can guidelines be both written and oral?
Definition
Yes
Term
What should your COTR (Contractig Officer Technical Representative) have a thorough understanding of?
Definition
Federal aquisition regulations, Tricare MCSC (Managed Care Support Contract) specifications, TMA (Tricare Management Activity) regulations, TFL (Tricare for life), and medicare specifications and all supplements thereof.
Term
What will COTRS (Contracting Officer Technical representative) participating in executive level meetings be expected to do?
Definition
Identify operational issues, develop recommendations to correct shortcomings, resolve problems, and to evaluate resource sharing/resource support proposals
Term
MTF COTR (Contracting Officer Technical Representative) responsibilities include developing and implementing surveillance programs to monitor the TSC's (Tricare Service Center) performance in meeting the Tricare contract and what other function?
Definition
Tricare for life (TFL) specifications
Term
What is expected of the MTF COTR (Contracting Officer Technical Representative)?
Definition
Ensure strict compliance with the Tricare contract and assist in development of required resource sharing agreements
Term
Who is responsible for ensuring the MCS (Managed care support)contractor performs the technical aspects of the contract?
Definition
COTR (Contracting Officers technical representative)
Term
The COTR (Contracting Officer technical representatve) will verify contractor's records regarding licensure, certification, an deducation remain current, and will post all changes to the...
Definition
COR (contracting Officer's representative) database
Term
If there are any deficiencies observed, who should the COTR (Contracting officer technical representative) communicate with both orally and written?
Definition
TRO (Tricare Regional Office)
COR (Contracting officer's representative), ACO (Administrative contracting officer) and MTF Commander
Term
Which is not a purpose of the COTR (Contracting Officer Technical Representative) contacts?
Definition
Ensure adequate standards of care
Term
Supplement services provided at MTF are an example of which type of resource sharing?
Definition
Internal
Term
Whose responsibility is it to develop and implement a resource-sharing program for seeking agreements with individual MTF Commander's?
Definition
The contractor (Humana, TriWest, HealthNet)
Term
Who provides the contractor with written approval/disapproval within 30 days of receipt of a resource-sharing agreement signed by the MTF Commander and the contractor?
Definition
TRO (Tricare Regional Office)
Term
What are the advantages of resource sharing?
Definition
(1)Other alternatives require the MTF to resource the project completely (2)Contractor can off set MTF's true marginal costs with copayments (3)Beneficiaries receive care at their preffered source and with no co-payment
Term
Who must the contractor receive approval from before implementing any agreements?
Definition
The TRO (Tricare Regional Office)
Term
One of the goals of resource sharing is to promote aggressively with what type of incentives?
Definition
"Win-Win"
Term
The contractor will submit the finalized plan to the TRO (Tricare Regional Office) no later than what time frame?
Definition
No later than 60 calendar days prior to the start of each new healthcare delivery option period.
Term
How often will the MCS contractor submit a revised resource sharing plan to the TRO (Tricare Regional Office)?
Definition
Annually
Term
What policy states that the DOD and the VA will enter into direct care sharing agreements?
Definition
DOD
Term
Internal resource sharing shall be based upon written agreements between the contractor and who else?
Definition
The MTF commanders, with TRO concurrence, and between the contractor and the resource-sharing. Providers, support personnel, and equipment maintenance vendors, and supply vendors.
Term
The contractor shall provide administrative support fulfilling the requirements of the resource sharing agreement within how many days?
Definition
No later than 10 calendar days following written notification by the TRO of the approval agreement
Term
Who will implement a formal DOD/VA healthcare resource sharing program?
Definition
TMA director (Tricare Management Activity)
Term
In regards to internal resource sharing, before a provider is permitted to practice in the MTF, he or she must be granted privileges by the...
Definition
MTF/CC
Term
For external resource sharing military health care personnel, who will ensure that the military health care personnel are appropriately licensed and have active clinical privileges with the network facility?
Definition
MTF commander
Term
Which resource agreement shall include the MTF's actual cost of providing the services, the monetary benefits received by the contractor, projected workload, administrative costs, workload credit split for the contractor and the MTF, and the contractor's actual cost of providing services in support of external resource-sharing providers?
Definition
External resource sharing agreements
Term
The contractor shall provide the MTF commander with a complete cost analysis within how many days of a written request?
Definition
Within 30 days (calendar) of a written request
Term
What is the goal of VA/DOD sharing agreements?
Definition
To improve access to, and quality, effectively, and effectiveness of the health care provided by the MHS (military Health System)and the Veteran's health administrative (VHA) to the respective beneficiaries of the MHS and the VHA).
Term
Who is responsible for ensuring that external-sharing providers are licensed to practice medicine in a united states jurisdiction during the term of resource sharing agreement?
Definition
The MTF Commander
Term
Who is responsible for costs borne by the contractor in providing services to Tricare beneficiaries in MTF's?
Definition
The contractor (TriWest, Humana, HealthNet) subject to the compensation arrangements specified in the contract.
Term
For internal sharing agreements, what shall the cost analysis include?
Definition
(1) Will include the contractor's actual cost of providing the personnel, equipment, equipment maintenance, and supplies (2)Anticipated support required within the MTF, the effect of the agreement on the bid price adjustment, the estimated support of MTF
Term
Who is responsible for querying the national practitioner data bank about each provider upon initial appointment and every two years thereafter and for providing the MTF commanders with copies of the National practiioner data bank report each time that one is received on a resource sharing provider?
Definition
The contractor (Humana, Triwest, and Health Net)
Term
Who will make certain that resource-sharing activity is correctly reported in teh remaining years of the contract?
Definition
Following the initial audit, the TRO (Tricare Regional Office)
Term
Are VA medical facilities subject to the same utilization management and quality assurance reuirements that apply to other network providers?
Definition
Yes
Term
Who is responsible for implementing a formal DOD/VA Health care resource sharing program?
Definition
The TMA (Tricare management Activity) Director
Term
Who shall have an independent certified public accounting firm perform audit procedures for each resource-sharing agreement to validate that resource-sharing activity is correctly reported under contract provisions?
Definition
Contractor
Term
What funding structure, mandated by the TMA (tricare management activity), must MTF commanders, resource management personnel and flight commanders review and manage?
Definition
BAG (Budget Activity Group)
Term
What is the name of the medical mission that requires a medical budget?
Definition
Defense Health Program
Term
How are RPMA (Real Property Management Account) funds allocated?
Definition
Based on PRV (Plant replacement value)
Term
To provide the combatant commanders with the best mix of forces, equipment, and support attainable within established fiscal constraints is the ultimate objective of the...
Definition
PPBES (Planning, Programming, Budgeting and execution system)
Term
Who mandated the BAG (budget activity group)funding structure?
Definition
TMA (Tricare Management Activity)
Term
Which phase of the PPBES (Planning, Programming, Budgeting, Execution system) is the process of determining objectives and specifying time-phased military force requirements to accomplish a mission?
Definition
Planning
Term
What is the purpose of the PPBES (Planning, programming, budgeting, exectution system) process?
Definition
(1) provide a structured systematic decision making process (2) allow ideas to be vetted across functional areas (3) examine strategies and make trade-offs between competing priorities and alternative remedies (4) Aid in understanding longterm implications of near term choices
Term
What is the future years defense plan?
Definition
The Primary programming document that serves as the basis for the budget
Term
What does budgeting involve?
Definition
The formulation of control is on the near-term resource requirements, allocation; and use, based upon the results of the planning and programming efforts
Term
What is the budget compiled by the AF MTF's called?
Definition
O&M (Operating and maintenance) operating budget
Term
What is the RC/CC code?
Definition
Four digit code used by the accounting system to monitor and report purchases by a work center
Term
Which PPBES (Planning, programming, budgeting, execution system) phase provides the opportunity to make assessments concerning current and previous resource allocations and whether the department achieved its planned performance goal?
Definition
Execution
Term
What is the EEIC (Element of Expense/Investment code) for medical supplies?
Definition
604
Term
What is a four-digit code used by the accounting system to monitor and report purchases by a work center?
Definition
RC/CC
Term
What is a grouping of forces, manpower, and costs associated with a military capability or support activity?
Definition
PEC (Program element code)
Term
Through the medical logistics flight, which office prepares, and provides guidance for the DWCF (Defense working capitol Fund), medical-dental stock division?
Definition
Air Force Medical Logistics office
Term
How often will RMO (Resource Management office) conduct cost center management meetings?
Definition
Quarterly
Term
Who maintains the MTF's cost center management program?
Definition
RMO (Resource management Office)
Term
What are the criteria for designation of a RC (Responsibility Center)?
Definition
Specific mission, span of control, sign managerial responsibility, significant resource consumption, measurable service provided
Term
Which is not a responsibility of the CCM (Cost Center manager/Management)?
Definition
Develop cost center management guide
Term
What are some typical duties of a CCM (Cost Center management/manager)?
Definition
Section budget development, justify financial and manpower resource requirement, monitor expenditure of section funds, control and monitor the consumption of work hours, supplies, equipment and services
Term
How often must CCM (Cost Center Manager/Management) meetings be conducted?
Definition
Quarterly
Term
What information should the cost center management guide provide?
Definition
How the DOD resource management, budgeting, financial management, local resource management policies and procedures, manpower management, workload reporting, and MEPRS requirements and accounting systems operate.
Term
What are some of the routine tasks that can be accomplished in the EAS system?
Definition
Update the ASD (Assistant Secretary of Defense), Loading personnel, financial and workload data
Term
Which form is used to issue funds to other Air Force units when it is impractical to route each request for funds through the accounting finance office?
Definition
AF Form 616, Fund Cite authorization (FCA)
Term
Who develops the spend plan?
Definition
RA (Resource Advisor)
Term
What is the most important MEPRS (Medical Expense and Performance Reporting System) table?
Definition
ASD (Assistant Secretary of Defense)
Term
When is each MTF required to transmit the MEPRS (Medical Expense and performance report system) data?
Definition
45 calendar days after the end of the month
Term
How is access to the EASIV Repository obtained?
Definition
Through the MAJCOM and the AF MEPRS (Medical Expense and Performance reporting system) program manager
Term
What document should be reviewd to ensure all commitments, obligations, and customer service orders are recorded accurately?
Definition
ODL (Open Document listing)
Term
What is the most important snapshot of financial activity the RMO (Resource Management Office) has and serves as their checkbook?
Definition
OBL (Operating Budget Leger)
Term
When will the MEPRS (medical Expense and performance reporting system) program manager receive the MEPRS financial data via the commanders resource intergration system (CRIS) software?
Definition
Prior to the seventh day of each month
Term
What information does the ODL (Open document listing) provide?
Definition
Open accounts payable and accounts receivable, purchase request and contract status information
Term
What are the two biggest advantages of the microbas (Micro-based budget automated system) and CRIS Systems?
Definition
Frequency in which you can receive the information, flexibility to create your own reports
Term
What form is used to establish unfilled customer orders between the ordering and performing activities in the accounting records?
Definition
AF Form 406, miscellaneous obligation/reimbursement document (MORD)
Term
For what purpose is the AF Form 9 utilized?
Definition
Order supplies, equipment, goods or services from suppliers through the base contracting office.
Term
What infromation does the EASIV cost table report contain?
Definition
Total expenses, performance factor workloads, cost per performance factor amounts at the detailed FCC code level
Term
How many total hours worked equals an FTE?
Definition
168
Term
Who must sign the AF Form 406, MORD (Miscellaneous obligation reimbursement document)?
Definition
The preparer and a certifying officer stating the funds are available
Term
What is the Primary purpose of EAS?
Definition
To process the MEPRS (Medical expense and performance reporting system) information and its associated reports
Term
What are the three types of expenses reflected in the EASIV allocation summary?
Definition
Direct expenses, purified expenses, step-down expenses
Term
What must accompany all financial plans?
Definition
Commander's statement
Term
Which is not key to a successful close-out?
Definition
Last minute obligations
Term
What serves as both a planning and programming guidance document to build the POM (Program objective memorandum)
Definition
MAPPG (Medical Annual Planning and programming guidance)
Term
What allows government agencies to continue operating during the first quarter of the fiscal year?
Definition
CRA (continuing resolution authority)
Term
How many priority levels are there when identifying costs required to complete the mission?
Definition
Three
Term
What is the key to a successful end of year close out?
Definition
pre-planning, constant review of management reports, cost center managers, close and continuous coordination w/base finance, MAJCOM, contracting, medical logistics, the accounting liason office
Term
What is the primary use of fallout dollars?
Definition
Purchase equipment
Term
What is the purpose of the MAJCOM MRT? (Manpower resources too)
Definition
It supoprts the MAJCOM's need for multiple facility data handling for the review, approval and modifications of all MTF and MAJCOM requirements.
Term
What are the goals of the MAPPG (Medical Annual Planning and Programming Guidance)?
Definition
Provide integrated , fiscally responsible roadmaps and to serve as the link between planning and programming.
Term
What was directed by DOD and Air Staff that involved converting military positions to civilian positions?
Definition
Balanced force initiative
Term
What enables the AFMS (Air Force Medical Service) to best meet the demands of expeditionary and in-garrison medical support?
Definition
Prioritization of resource balances
Term
What information is provided on the UMD (Unit Manpower document)?
Definition
Every funded, unfunded and contracted manpower requirement as validated by the POM (Program objective memorandum)
Term
What information is provided on the UPMR (Unit personnel management roster)?
Definition
Names, SSAN, Projected gains, Projected Losses
Term
What is a tool a unit can use to request a change to manning levels?
Definition
ACR (Authorizing change request)
Term
Prior to submitting an ACR (Authorizing change request) who must sign the RMO (Resource management office) check with to ensure no impact is made of the unit's deployment requirements?
Definition
Unit deployment manager
Term
What is the only way to request changes to an organizations UMD (Unit Manpower document)?
Definition
ACR (Authorization change request)
Term
who determines the format and requirements for submittal of ACRs (Authorization change request)
Definition
The manpower office
Term
What panel is built around the OSD (office of the secretary of defense), comptroller BAG, for ease of dovetailing into the DOD PPBES (Planning, programming, budgeting and execution system)?
Definition
AFMS (Air Force Medical Service) Panels
Term
How many panels will the AFMS (Air Force Medical Service) use to identify and champion necessary changes?
Definition
9
Term
The long view strategy looks at the AFMS (Air Force Medical System) from a strategic viewpoint of how many years?
Definition
ten years and beyond
Term
The AFMS (Air Force Medical Service) will use how many panels to identify and champion changes?
Definition
Nine
Term
What is the objective for the business planning process?
Definition
To achieve optimal utilization of the Defense health program resources, Provide management accountability at every level of the military health system, Ensure currency so the AF can deploy ready airmen
Term
What does the MTF commander include in the business plan?
Definition
The provision of care to selected beneficiaries to maintain readiness skills and clinical competency, and to maximize utilization of the facility after the needs of Tricare Prime enrollees have been met.
Term
The Longview strategy will position the AFMS (Air Force Medical Service) for the greatest return with the least risk. The outcome will be the highest state of readiness, the best health status, and the...
Definition
Lowest overall cost
Term
Which analysis is accomplished by analyzing the private sector and direct care risk?
Definition
CCA (Currency Case Analysis)
Term
What is the means to link planning and programming and provides an integrated and fiscally responsible roadmap, assuring progress in support of AFMS (Air Force Medical Service) strategic initiatives?
Definition
MAPPG (Medical Annual Planning, programming guidance)
Term
Who is responsible for developing MTF by MTF blueprints based on the results of the RCA, CCA (Currency Case Analysis), BCA (Business Case Analysis) analysis with subsequent local assessment (micro-level) by MTFs?
Definition
Air Staff and MAJCOMs
Term
The intent of the AFMS (Air Force Medical Service) long view strategy is to position the AFMS for the greatest return with least risk. What is the outcome?
Definition
The highest state of readiness, the best health status, and the lowest cost of care.
Term
The AFMS long view strategy will use an algorithm that balances which three things?
Definition
RCA, CCA (currency case analysis), BCA (business care analysis)
Term
What is accomplished by analyzing the private sector and direct care risk?
Definition
CCA (currency case analysis)
Term
Which analysis places the assets where the population drives the largest financial risk?
Definition
BCA (Business case analysis)
Term
What tool is a one page summary for each MTF containing necessary information to perform an RCA-CCA (currency case analysis), BCA (business case analysis) within a product line?
Definition
MTF Summary Tool
Term
Which is not a tool used to formulate the initial baseline manpower requirements for the MAPPG (Medical Annual planning and programming guidance)
Definition
MTF Summary Tool
Term
Where does integration of readiness missions and reguirements, military construction, information management/information technology, financial, manpower, education and training, and personnel requirements occur?
Definition
IRB (Integrated resource board)
Term
What is the PSRM (Private sector recapture model) used for?
Definition
To recapture private sector care within existing resources
Term
What is the purpose of the manpower mix decision process?
Definition
To determine the type of manpower to use when validating manpower requirements
Term
Who is responsible for providing active duty military authorizations?
Definition
Each MAJCOM
Term
Who approves the interim use of civilians until military resources can be planned and made available?
Definition
MAJCOM
Term
The decision process is used to determine the type of manpower to use when validating?
Definition
Manpower requirements
Term
Who is responsible for providing active military authorizations?
Definition
MAJCOM
Term
Air Reserve Force Authorizations must be identified to....
Definition
HQ USAF/XP
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