Busy. Please wait.

Forgot Password?

Don't have an account?  Sign up 

show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.

By signing up, I agree to StudyStack's Terms of Service and Privacy Policy.

Already a StudyStack user? Log In

Reset Password
Enter the email address associated with your account, and we'll email you a link to reset your password.

Remove ads
Don't know (0)
Know (0)
remaining cards (0)
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Medicare Facts

Final Review

Who is generally eligible for Medicare? Primarily for ages 65+ who have paid (or are spouse of payee) into the plan for 40 quarters or twenty years.
Other persons eligible for Medicare are? Retired railroad workers; those currently receiving SS benefits; persons with end-stage (renal) kidney disease
When was Medicare enacted? In 1965, under the SS Act. It is a federal insurance program.
Define Medicare Part A? automatic when eligibility and deductible met; covers hospital (inpatient) costs; hospice; limited nursing home stays; home health
Define Medicare Part B? (optional) premiums, deductibles, and co-ins. are required; covers physician costs; outpatient services; DME (Durable Medical Equipment) and medical supplies
Define Medicare Part C? (HMO type coverage) called Medicare Advantage; Must be enrolled under part A & B to participate.
Define Medicare Part D? (optional) Covers approved pharmaceuticals
Assignment of Benefits when a pt gives written authorization for reimbursement to the physician for billed charges
Coordination of Benefits one insurance plan working with another to determine how much each plan pays (who pays first?)
Insured The person who is covered by the benefits plan
Dependent Spouse or child covered under the insured's benefits plan
Fee Schedule Amount that will be paid by the insurance plan for each procedure or service is based on this? (Dr.'s list of customary charges)
Medicaid Government sponsored program that provides health benefits to low income or indigent persons.
Workers Compensation Expenses that result form work-related illness/injuries are covered by this.
(EOB)Explanation of Benefits Statement issued to both provider & Pt. that details a payment that has been made by the plan
Where could a patient find his/her co-pay, deductible, allowable amount and amount paid to the provider for health services? On the Explanation of Benefits (EOB) statement.
Pre-existing condition a disease diagnosed before the effective date of coverage by the insurance plan
Deductible Amount of eligible charges each pt. must pay each calendar year before the plan begins to pay benefits.
Precertification Process of determining whether a service or procedure will be covered by the insurance provider
What is CHAMPVA? Plan under which medical bills of spouses/children of vets with total permanent, service-connected disabilities are covered.
Capitation Making a payment to a provider based on a "fixed amount" per enrollee assigned to that provider regardless of services provided.
HMO - Health Maintenance Organization A group of physicians who have a contract to provide services to participating pts. for a pre-determined fee.
QIO - Quality Improvement Organization A group of physicians who review cases for appropriateness of hospitalizations & discharges (are visits necessary, cost effective?)
Usual, customary and reasonable Database or list of charges for each procedure; indicates the charge by a majority of physicians in a geographic area.
Premium Amount paid by an individual to purchase benefits of a health insurance policy.
PCP - Primary Care Physician A general practioner who oversees pts. in an HMO or PPO.
Exclusion A condition or circumstance for which the health insurance policy will not provide benefits.
Disability Income Insurance Insurance coverage that provides a specific monthly or weekly income when an individual becomes unable to work because of illness/injury.
Co-payment Amount of money owed by insured to the provider at the time of service is called this
Birthday rule Determination of the primary carrier is according to birth month when a dependent child is covered by benefit plans of both parents.
DRG - Diagnosis Related Groups Hospital payment system that catagorizes pts. by diagnosis/treatment.
UCR payment basis Usual, customary, and reasonable; What a majority of physicians in a specific geographic area charge for procedures/services rendered
Participating Provider If Medicare sends a check to a physician's office he/she is this type of provider?
Created by: cchouinard