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Med. Insurance Terms

Medical Insurance in a Flash Chapter 8

QuestionAnswer
What percentage of the allowed amount is paid by Medicare? 80%
What percentage of the allowed amount is paid by a secondary insurer? 20%
What is the capitated Medicare plan called? Medicare HMO
One of the colorectal screening tests covered Medicare? Referral
Medicare HMO patients must obtain one of these before going for tests or to a specialist? Occult blood in stool, flexible sigmoidoscopy, colonoscopy, or brain enema
Medicare will pay for a discontinued service if it is billed with that modifier? Modifier-53
What is the name of the suplemental insurance that is provided by private insurance? Medigap
What is the estimated number of americans with low bone mass? 34 Million
What is the disease of the optic nerve for which Medicare covers a screening test? Glaucoma
A Medicare Summary Notice was previously called what? Explanation of Medicare Benefits / EOMP / EOB
What is the name of the test used to look for polyps in the lower third of the colon? Fiberoptic sigmoidoscopy
How often can Medicare patients have a fiberoptic sigmoidoscopy? Every 4 years for Medicare patients over 50 and not at high risk
Hyperparathyroidism is an indication for what testing? Bone mass measurements
What are two screening tests performed for prostate cancer? PSA and DRE
What are the three high-risk patient groups for coverage of glaucoma screening? Patients with diabetes mellitus patients with a family history of glaucoma African Americans age 50 and over
What ethnic group is most likely to be at risk of prostate cancer? African American
To whom is the medicare summary notice sent? The Patient
What are the coverage conditions for medicare coverage of pneumococcal vaccine (PPV)? Medicare will cover one vaccination in the lifetime of the patient.
How often are Medicare summary notices mailed? Every 90 Days.
Medicare patients are not required to pay co-insurance or a deductible for what two vaccines? Influenza and pneumococcal
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