# BAS 02 Medicare
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| On Monday 10.27.2014! | Bring your HCPCS coding book to class.
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| eligibility | Requirements to qualify for benefits
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| benefit period | Period of time that a person qualifies for coverage in an insurance policy.
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| CMS | Center for Medicare and Medicaid Services. Administers the Medicare and State Medicaid programs.
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| Medicare Part A premium | Free if you qualify for a social security check.
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| Cost to purchase medicare part A if you don't qualify for social security benefits | $426/month!
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| Part A Medicare covers | Hospital, SNF, hospice, non-medical religious facility
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| "accept assignment" means | The provider accepts the "allowable amount" for payment. This is full payment
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| "allowable charges" | The amount that Medicare pays for a service.
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| ABN | Advanced Beneficiary Notice. Form used if doctor is charging more than the "allowable charges"
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| You pay ___% of the allowable amount for services with Medicare Part B. | 20
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| Long term care | non-medical care. Includes daily bathing, eating, grooming
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| 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.
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| dual eligibles | Individual eligible for Medicare and Medicaid
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| ESRD | End stage renal disease
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| Medigap | Insurance policy that covers missing benefits in the medicare insurance. Also called supplemental plan.
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| non-PAR | Doctor who does not "accept assignment". These doctors can charge only up to 115% of the allowable charge.
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| PAR | doctor who "accepts assignment". This doctor is paid at 80% of the allowable charge.
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| 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.
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| 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
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| Medicare PSO, HMO, PPO, | Managed care plans allwed for Medicare.
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| Medicare Part C | A medicare plan that includes A and B. This also adds some coverage that both A and B do not cover.
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| Medicare originally was passed to cover | Persons 65yrs and older.
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| In 1972 Medicare was expanded to cover: | Disabled persons under 65 and those with ESRD, need dialysis or kidney transplant.
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| If you qualify Medicare Part A will cost you... | Nothing
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| Cost sharing for Medicare includes | premiums, coinsurance and copays
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| Medicare Part B can cover for: | Office visits and usual physician services.
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| Medicare Part C might include | Part D drug coverage.
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| Home health, Hospice care and SNF care is covered by: | Medicare Part A
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| In order to be covered in Part A the patient must be: | An inpatient.
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| Medicare will not pay unless | the doctor services are medically necessary.
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| Medicare Part B can cover fora: | DME
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| DME | Durable medical equipment.
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| Costs for Medicare Part B are determined by: | The Part B carrier.
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| A person can sign up for Part B at anytime without any penalties | FALSE
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| The percentage of "allowable charges" that Medicare Part B pays for is: | 80%
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| Medicare Part C is government administered | FALSE. The Part C is handled through a managed care carrier.
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| Medicare Part C can cover for: | eyeglasses, hearing aids, and dental care.
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| The deductible for Medicare is | $320
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| The "donut hole" of part D means: | The patient is not covered for cost of prescription drugs.
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| 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.
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| Medicare pays secondary to: | Veterans benetits, workers compensation, and black lung benefits.
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| Medical necessity requires | that the tests and exams are appropriate to diagnose and the treatment is necessary to cure the patient.
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| Palpate | Medical exam by touching
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| Percussion | Tapping on the body to assess the underlying structure or area.
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| ROM | Range of motion
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| PO | per oral. Meds taken by mouth
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| Suppository | Medication that is absorbed in a mucous membrane.
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| Topical medication | skin cream
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| catheter | Plastic tube inserted into the body. Can be used to withdraw fluids or administer medications.
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| HCPCS are level ____ codes. | II
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| HCPCS stands for | Healthcare Common Procedure Coding System
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| Why is HCPCS used? | To accodate for services not in the CPT
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| The drugs in the drug table are listed alphabetically using the ___________ name. | generic
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| Level I and Level II codes are: | CPT and HCPCS
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| Level I and Level II codes are used to: | Report outpatient services.
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| Modifiers | Helps explain something about a code. -LT left, -RT right,R=residence, H=hospital, etc.
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| 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.
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