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Medicare Part 1

Study of Eligibility, coverage, history and management

TermDefinition
Medicare federal health insurance [program created in 1965 as Title 18 of the Social Security Act (SSA). Managed by CMS (Centers for Medicare and Medicaid Services)
benefit period period of time that begins when an individual is admitted to a hospital or skilled nursing facility and ends 60 days after the discharge date; used to determine deductibles and co-payments for Medicare Part A
Medicare Advantage Manged care alternative to original Medicare FFS plan. Offering HMO/PPO style plans including Parts C and D.
Medicare Administrative Contractor Independent companies hired to process Medicare claims. Issue payments and claim decisions to providers and patients. Formerly known as fiscal intermediaries or insurance carriers
Qualified Medicare Beneficiary Medicaid program for beneficiaries of Medicare who need help paying for Medicare services, paying for Part A and B premiums, deductibles, and coinsurance
Relative Value Unit numeric unit designating physician work, practice expenses, and malpractice costs
Specified Low-Income Medicare Beneficiary Medicaid program for Medicare beneficiaries with incomes slightly exceeding the federal poverty level that pays for Medicare Part B premiums for those also enrolled in Part A
Lifetime Reserve Days fixed number of days that Medicare will cover when a beneficiary is hospitalized for more than 90 days during a benefit period. Up to sixty additional days in the hospital once during the patients lifetime. Coverage does not include the per-day deductible
Advance Beneficiary Notice notice issued to patient prior to rendering of services when it is believed that Medicare will not cover the service that is planned.
National Correct Coding Initiative implemented by CMS in 1996; promotes physician and provider compliance with Medicare diagnosis and procedure coding guidelines and ensures appropriate payment for physician and provider services
health insurance claim number Medicare beneficiary ID number. The social security number of the wage earner followed by a one or two character alpha suffix
Created by: tina.reynolds