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# BAS 02 Medicare

On Monday 10.27.2014! Bring your HCPCS coding book to class.
eligibility Requirements to qualify for benefits
benefit period Period of time that a person qualifies for coverage in an insurance policy.
CMS Center for Medicare and Medicaid Services. Administers the Medicare and State Medicaid programs.
Medicare Part A premium Free if you qualify for a social security check.
Cost to purchase medicare part A if you don't qualify for social security benefits $426/month!
Part A Medicare covers Hospital, SNF, hospice, non-medical religious facility
"accept assignment" means The provider accepts the "allowable amount" for payment. This is full payment
"allowable charges" The amount that Medicare pays for a service.
ABN Advanced Beneficiary Notice. Form used if doctor is charging more than the "allowable charges"
You pay ___% of the allowable amount for services with Medicare Part B. 20
Long term care non-medical care. Includes daily bathing, eating, grooming
coordination of benefits Coordinating the insurance companies to pay only up to the total charges. Each insurance will pay only a fraction of the total up to 100% of the charges.
dual eligibles Individual eligible for Medicare and Medicaid
ESRD End stage renal disease
Medigap Insurance policy that covers missing benefits in the medicare insurance. Also called supplemental plan.
non-PAR Doctor who does not "accept assignment". These doctors can charge only up to 115% of the allowable charge.
PAR doctor who "accepts assignment". This doctor is paid at 80% of the allowable charge.
RBRVS Resource Based Relative Value System. This is the basis for the medicare fee schedule. It is based upon the specialty, procedure or service, and the geographical region.
MSP Medicare as secondary payer. Medicare is primary for retiree insured, employer insured with under 20 employees, and for disabled persons covered by another's employer with less than 100 employees
Medicare PSO, HMO, PPO, Managed care plans allwed for Medicare.
Medicare Part C A medicare plan that includes A and B. This also adds some coverage that both A and B do not cover.
Medicare originally was passed to cover Persons 65yrs and older.
In 1972 Medicare was expanded to cover: Disabled persons under 65 and those with ESRD, need dialysis or kidney transplant.
If you qualify Medicare Part A will cost you... Nothing
Cost sharing for Medicare includes premiums, coinsurance and copays
Medicare Part B can cover for: Office visits and usual physician services.
Medicare Part C might include Part D drug coverage.
Home health, Hospice care and SNF care is covered by: Medicare Part A
In order to be covered in Part A the patient must be: An inpatient.
Medicare will not pay unless the doctor services are medically necessary.
Medicare Part B can cover fora: DME
DME Durable medical equipment.
Costs for Medicare Part B are determined by: The Part B carrier.
A person can sign up for Part B at anytime without any penalties FALSE
The percentage of "allowable charges" that Medicare Part B pays for is: 80%
Medicare Part C is government administered FALSE. The Part C is handled through a managed care carrier.
Medicare Part C can cover for: eyeglasses, hearing aids, and dental care.
The deductible for Medicare is $320
The "donut hole" of part D means: The patient is not covered for cost of prescription drugs.
Medicare is secondary payer if the patient is covered by a private plan from another person or... A person is covered by a comprehensive plan from the employer.
Medicare pays secondary to: Veterans benetits, workers compensation, and black lung benefits.
Medical necessity requires that the tests and exams are appropriate to diagnose and the treatment is necessary to cure the patient.
Palpate Medical exam by touching
Percussion Tapping on the body to assess the underlying structure or area.
ROM Range of motion
PO per oral. Meds taken by mouth
Suppository Medication that is absorbed in a mucous membrane.
Topical medication skin cream
catheter Plastic tube inserted into the body. Can be used to withdraw fluids or administer medications.
HCPCS are level ____ codes. II
HCPCS stands for Healthcare Common Procedure Coding System
Why is HCPCS used? To accodate for services not in the CPT
The drugs in the drug table are listed alphabetically using the ___________ name. generic
Level I and Level II codes are: CPT and HCPCS
Level I and Level II codes are used to: Report outpatient services.
Modifiers Helps explain something about a code. -LT left, -RT right,R=residence, H=hospital, etc.
If an ampule is opened and only half of the medicine is given you will... Code for the entire ampule. There should also be notes stating that the rest of the medicine was wasted.
Created by: rjmtoss