Health Insurance Chapter 14, 15
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| This begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days | benefit period
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| May be used only once during a patient's lifetime and are usually reseved for use during the patient's final, terminal hospital stay (60 days) | lifetime reserve days
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| Includes HMO's, PPO's, and PSO's though which a Medicare beneficiary may choose to receive health care coverage and services. Often provide a greater array of services and smaller copayment than conventional medicare | coordinated care plan
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| A denial of otherwise covered services that were found to be not "reasonable and necessary" | medical necessity denial
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| A plan that provides both medicare and medicaid coverage to certain eligible beneficiaries | medicare-medicaid crossover
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| This helps individuals whose assets are not low enough to qualify them for medicaid by requiring states to pay their medicare part A and B premiums, deductibles, and coinsurance amounts | qualified medicare beneficiary program (QMBP)
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| Helps low-income individuals by requiring states to pay their Medicare part B premiums | qualifying individual (QI-1)
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| Helps individuals who received social security and medicare because of disability, but who lost their social security benefits and free medicare part A because they returned to work and their earnings exceeded the limit allowed. | qualified disabled working individual (QDWI)
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| Enables Medicare beneficiaries to participate in mass PPV and influenza virus vaccination programs offered by public health clinics (PHC) and other entities that bill medicare carriers | roster billing
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| Helps low-income individuals by requiring states to pay their medicare part B premiums | specified low-income medicare beneficiary (SLMB)
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| Some medicare literature uses this term in place of benefit period; formerly called spell of sickness | spell of illness
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| This reimburses institutional providers for inpatient, hospice, and some home health services | medicare part A
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| This reimburses institutional providers for outpatient services and physicians for inpatient and office services | medicare part B
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| What is another name for medicare part A | medicare hospital insurance
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| What is another name for medicare part B | medicare medical insurance
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| What is another name for medicare part C | medicare advantage
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| What is another name for medicare part D | medicare prescription durg plans
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| Formerly called Medicare+Choice, includes managed care and private fee-for-service plans that provided contracted care to medicare patients | medicare part C
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| This adds prescription drug coverage to the original medicare plan, some medicare cost plans, some medicare private fee-for-service plans and medicare medical savings account plans | medicare part D
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| Which is a federal program administered by CMS? | medicare
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| Medicare Part___ reimburses institutional providers for inpatient, hospice, and some home health services | part A
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| Which is a characteristic of Medicare enrollment | eligible individuals are automatically enrolled, or they apply for coverage
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| A Medicare benefit period is defined as beginning the first day of hospitalization and ending when: | the patient has been out of the hospital for 60 consecutive days
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| Skilled nursing facility (SNF) inpatients who meet medicare's qualified diagnosis and comprehensive treatment plan requirements when they are admitted after a 3-day minimum acute hospital stay are required to pay the medicare rate during which period? | days 21-100
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| The original medicare plan is also called medicare: | fee-for-service
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| Medigap coverage is offered to medicare beneficiaries by | commercial payers
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| Which has been banned as a result of legislation passed by some states? | balance billing
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| Which is a written document provided to a medicare beneficiary by a provider prior to rendering a service that is unlikely to be reimbursed by medicare | advance beneficiary notice (ABN)
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| Individuals who are entitled to medicare and eligible for some type of medicaid benefit are called: | dual eligibles
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| Annual income guidelines established by the federal government | federal poverty level
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| Provides medical and health-related services to certain individuals and families with low incomes and limited resources (the medically indigent) | medicaid
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| Sometimes called Medicaid eligibility verification system (MEVS) allows providers to electronically access the state's eligibility file | recipient eligibility verification system (REVS)
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| This makes cash assistance available, for limited time, for children deprived of support because of a partent's absence, death, incapacity, or unemployment | tempory assistnace for needy families (TANF)
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| This allows states to create or expand existing insurance programs and provides more federal funds to states for the purpose of expanding medicaid eligibility to include a greater number of children who are currently uninsured | state childrens health insurance program (SCHIP)
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| Medicaid is jointly funded by federal and state governments, and each state: | administers its own medicaid program
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| How often do state legislatures change medicaid eligibility requirements? | during the year, sometimes more than once
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| Medicare Part A coverage is available to individuals under the age of 65 who: | have a disability or end-stage renal disease
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| Temporary hospitalization of a patient for the purpose of providing relief from duty for the nonpaid primary caregiver of a patient is called______care: | respite
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| Medicare Part B will cover some home health care services if the patient: | is not eligible for medicare part A
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| The maximum fee a nonPAR may charge for a covered service is called the: | limiting charge
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