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Health Insurance and Claims Chapter 14 & 15

what begins the first day of hospitalization and ends when the Medicare patient has been out of the hospital for 60 consecutive days benefit period
This is also called a managaaed care plan. coordinated care plan
Under Medicare A when all of the inpatient benefits have been exhausted the patient can choose to use all or some of their____________. lifetime reserve days
What is it called when there is a denial of otherwise covered services that were found to be not "reasonable and necessary"? medical necessity denial
This is a combination of two programs and it available to Medicare-eligible persons with incomes below the federal poverty level. Medicare-Medicaid crossover
What are the four dual eligible Medicare beneficiary groups? qualified Medicare beneficiary program (QMBP); qualifying individual (QI-1); qualified disabled working individual (QDW); Specified Low-income Medicare Beneficiary (SLMB)
What process does a Public Health Clinic or other entity use to bill for their mass vaccination program? roster billing process
What is another term that can be used in place of benefit period? spell of illness
What do you call an individual who is entitled to Medicare and eliglible for some type of Medicaid benefit? dual eligibles
Income guidelines established annually by the federal government. federal poverty level (FPL)
Cost-sharing program between the federal and state governments to provide health care services to low-income Americans. Medicaid
What does a provider use to make sure a Medicaid patient has coverage on a specific date of service? recipient eligibility verification system (REVS)
This program makes cash assistance available on a time-limited basis for children deprived of support because of a parent's death, incapacity, absence, or unemployment. Temporary Assistance for Needy Families (TANF)
This was established to provide or expand health insurance coverage to uninsured children. State Children's Health Ins. Program (SCHIP)
Medicare no longer uses the term explanation of Medicare benefits, now they use what? Medicare Summary Notice
If you suspect that Medicare will deny services that you want for your Medicare patient what must you get them to sign? Advance Beneficiary Notice (ABN)
Created by: Kcompleta