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Medicare Part 1
Study of Eligibility, coverage, history and management
| Term | Definition |
|---|---|
| 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
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