IBC12 Word Scramble
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Question | Answer |
What is the limiting charge? | % limit on fees that non par physicians may bill medicare above the allowed amount |
Whatis an HMO cost plan? | beneficiaries receive medicare-covered services from sources in or outside the HMO network |
What is an HMO risk plan? | when enrolled in HMO risk plan, they receive Medicare-covered services (except emergency, urgent need, and prior authorized services.) only from providers who are contracted members of the HMO network |
What is respite care? | a short-term hospice inpatient stay for a terminally ill patient to give temporary relief to the person who regularly assists with home care of a patient |
Why was Medicare started? | to provide coverage for the aged, retired, disabled individuals, and people who have chronic kidney disease |
What does an I.D. card contain? | the wage earners SS# followed by an alpha letter along with effective dates |
Who are medigap insurance benefits regulated by and what does it include? | regulated by the federal government (includes basic benefits) |
What is the federal false claims amendment act created for? | to prevent overuse of services and spot medicare fraud |
What do Stark I & II regulations guard against? | prohibit a physician who has a financial relationship to a family |
When billing Medicare supplemental, when would you bill them? | secondary after primary has paid |
What are non-benefit services? | foot care, routine care, eyecare |
When a patient has medicare and medicaid what does medicaid pay? | the deductible, premium, and coinsurance |
What is Medicare Part C? | Medicare Plus(+) Choice plans offer a number of health care options in addiction to those available under Part A & B. Plans may include health maintenance organizations, fee-for-service plans, provider-sponsored organizations, etc. |
What is a benefit period? | begins the day a patient enters a hospital and ends when the patient has not been a bed patient in any facility for 60 days. Renewed every time patient begins new benefit period. No limit. Limits apply to hospice care. |
What is correct coding initiative? | Federal legislation that attempts to eliminate unbundling or other inappropriate reporting or procedural codes for professional medical services rendered to patients |
What is a fiscal intermediary? | insurance carrier that receives and processes claims from physicians and other suppliers of service for Medicare Part B |
What is Medicare managed care? | Medicare enrollees have the right to join and assign their Medicare benefits to HMO's. The patient does not need a Medicare supplemental insurance plan |
WHat does it mean when the letter precedes the insurance claim number on the I.D. card | Medicare RR recipient |
What is the modifier when a waiver of liability is signed? | GA (MSP) |
What does Medicare Part A cover? | hospital services |
What does Medicare Part D cover? | prescription services |
When does a patient not need A & B? | when they are covered under Medicare Part C |
What levels of HCPCS does Medicare recognize? | levels I, II, & III |
How is Medicare funded? | federally funded |
What does Medicare Part B cover? | physician services |
Created by:
sanzijessica
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