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chapter 14
| Question | Answer |
|---|---|
| PACE | Program of All-inclusive Care for Elderly |
| The goal of PACE is | to help people remain independent and live in their community as long as possible. |
| The largest single medical benefits program in the U.S. is | Medicare |
| The Privacy Act of 1971 regulates | ROI (release of information) |
| A demonstration/pilot program is | a special project that tests improvements in Medicare coverage, payment and quality of care |
| Medicare savings programs | help people with low income and asset levels pay for health care coverage |
| The Centers for Medicare and Medicaid Services (CMS) is | responsible for the operation of the Medicare program and for selecting Medicare Administrative Contracts (MAC) |
| The benefit period was formerly known as | 1) spell of illness or 2) spell of sickness |
| Medigap is designed to | supplement Medicare benefits by paying for services that Medicare does not cover |
| A benefit period begins | the first day of hospitalization and ends when the patient has been out of the hospital for 60 days. |
| Medicare Part A | covers institutional providers for inpatient services |
| Medicare Part B | Physician services, outpatient hospital and other services not covered by Medicare ( also home health services if patient is not covered by part A) |
| Medicare Part C | Medicare Advantage Plan....If you join a Medicare Advantage Plan, the plan will provide all of your Part A ( Hospital insurance) and Part B ( Medical Insurance) coverage. |
| Medicare Advantage Plans may offer | extra coverage, such as vision, hearing, dental, and/or health and wellness program. Most include Medicare prescription drug coverage ( Part D) |
| Medicare pays | a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. |
| However, each Medicare Advantage Plan can charge different out-of pocket costs and have different rules for how you get service | ( like whether you need a referral to see a specialist or if you have to go only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent). These rules can change each year. |
| Medicare Part D | prescription drug coverage plan |
| Individuals 65 or over don't pay | a monthly premium for Medicare Part A if they or their spouse paid Medicare taxes while working |
| General Medicare eligibility requires an individual or their spouse to: | 1) Be at least 65 years old 2) Be a citizen or permanent resident of the U.S. 3) Have worked at least 10 years in Medicare-covered employment |
| A person can also qualify for Medicare services if | they are younger than 65 years old if they are disabled or diagnosed with ESRD (end-stage renal disease.) |
| Annual Medicare deductible is | $135 |
| Special incentives mandated by Congress to increase the number of healthcare provider agreements with Medicare include: | 1) Direct payment of all claims 2) Publication of PAR (participating provider) directory to all Medicare patients 3) 5% higher fee schedule |
| General enrollment period | is held January 1st through March 31st each year |
| Hospice care is provided when | the provider is unable to do anything further to stop the progression of disease and the patient is only treated to relieve pain/discomfort (palliative care) |
| Medicare limits hospice care to four benefit periods | 1)Two periods of 90 days each 2) One 30 day period 3) A final "lifetime" extension of unlimited duration |
| RVU | Relative Value Unit...where resources such as physician work, practice expense, malpractice expenses are taken into consideration when calculating physician fee schedules. |
| Patients can join the Medicare Prescription Plan by | paying a monthly premium and annual deductible |
| Medicare cost Plan | Individual receives healthcare from a non-network provider; original Medicare plan covers the services |
| Medicare Savings Account | money managed by Medicare-approved insurance company |
| Patients confined to a psychiatric hospital are allowed | 190 lifetime reserve days instead of the 60 days allotted for stay in an acute care hospital. |
| Initial Enrollment Period | provide opportunity to enroll in Medicare before the age of 65 |
| Respite Care | is temporary hospitalization of a terminally ill patient to provide relief for the nonpaid caregiver |
| Medicare Select | Medigap insurance that requires enrollees to use a network of providers in order to receive full benefits |
| When a patient selects Medicare hospice benefits stop with the exception of | physician services for treatment for conditions not related to the patients terminal diagnosis |
| During the periods final terminal hospital stay | there are 60 lifetime reserve days that may be used only once during a patient's lifetime and are usually reserved for this use |
| Medicare Advantage | Managed care and private fee-for-service plans provided to Medicare patients |
| Benefit period beings | the first day of hopitalization |
Created by:
drea08
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