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# BAS 02 Medicare
| Question | Answer |
|---|---|
| On Monday 10.27.2014! | Bring your HCPCS coding book to class. |
| eligibility | Requirements to qualify for benefits |
| benefit period | Period of time that a person qualifies for coverage in an insurance policy. |
| CMS | Center for Medicare and Medicaid Services. Administers the Medicare and State Medicaid programs. |
| Medicare Part A premium | Free if you qualify for a social security check. |
| Cost to purchase medicare part A if you don't qualify for social security benefits | $426/month! |
| Part A Medicare covers | Hospital, SNF, hospice, non-medical religious facility |
| "accept assignment" means | The provider accepts the "allowable amount" for payment. This is full payment |
| "allowable charges" | The amount that Medicare pays for a service. |
| ABN | Advanced Beneficiary Notice. Form used if doctor is charging more than the "allowable charges" |
| You pay ___% of the allowable amount for services with Medicare Part B. | 20 |
| Long term care | non-medical care. Includes daily bathing, eating, grooming |
| coordination of benefits | Coordinating the insurance companies to pay only up to the total charges. Each insurance will pay only a fraction of the total up to 100% of the charges. |
| dual eligibles | Individual eligible for Medicare and Medicaid |
| ESRD | End stage renal disease |
| Medigap | Insurance policy that covers missing benefits in the medicare insurance. Also called supplemental plan. |
| non-PAR | Doctor who does not "accept assignment". These doctors can charge only up to 115% of the allowable charge. |
| PAR | doctor who "accepts assignment". This doctor is paid at 80% of the allowable charge. |
| RBRVS | Resource Based Relative Value System. This is the basis for the medicare fee schedule. It is based upon the specialty, procedure or service, and the geographical region. |
| MSP | Medicare as secondary payer. Medicare is primary for retiree insured, employer insured with under 20 employees, and for disabled persons covered by another's employer with less than 100 employees |
| Medicare PSO, HMO, PPO, | Managed care plans allwed for Medicare. |
| Medicare Part C | A medicare plan that includes A and B. This also adds some coverage that both A and B do not cover. |
| Medicare originally was passed to cover | Persons 65yrs and older. |
| In 1972 Medicare was expanded to cover: | Disabled persons under 65 and those with ESRD, need dialysis or kidney transplant. |
| If you qualify Medicare Part A will cost you... | Nothing |
| Cost sharing for Medicare includes | premiums, coinsurance and copays |
| Medicare Part B can cover for: | Office visits and usual physician services. |
| Medicare Part C might include | Part D drug coverage. |
| Home health, Hospice care and SNF care is covered by: | Medicare Part A |
| In order to be covered in Part A the patient must be: | An inpatient. |
| Medicare will not pay unless | the doctor services are medically necessary. |
| Medicare Part B can cover fora: | DME |
| DME | Durable medical equipment. |
| Costs for Medicare Part B are determined by: | The Part B carrier. |
| A person can sign up for Part B at anytime without any penalties | FALSE |
| The percentage of "allowable charges" that Medicare Part B pays for is: | 80% |
| Medicare Part C is government administered | FALSE. The Part C is handled through a managed care carrier. |
| Medicare Part C can cover for: | eyeglasses, hearing aids, and dental care. |
| The deductible for Medicare is | $320 |
| The "donut hole" of part D means: | The patient is not covered for cost of prescription drugs. |
| Medicare is secondary payer if the patient is covered by a private plan from another person or... | A person is covered by a comprehensive plan from the employer. |
| Medicare pays secondary to: | Veterans benetits, workers compensation, and black lung benefits. |
| Medical necessity requires | that the tests and exams are appropriate to diagnose and the treatment is necessary to cure the patient. |
| Palpate | Medical exam by touching |
| Percussion | Tapping on the body to assess the underlying structure or area. |
| ROM | Range of motion |
| PO | per oral. Meds taken by mouth |
| Suppository | Medication that is absorbed in a mucous membrane. |
| Topical medication | skin cream |
| catheter | Plastic tube inserted into the body. Can be used to withdraw fluids or administer medications. |
| HCPCS are level ____ codes. | II |
| HCPCS stands for | Healthcare Common Procedure Coding System |
| Why is HCPCS used? | To accodate for services not in the CPT |
| The drugs in the drug table are listed alphabetically using the ___________ name. | generic |
| Level I and Level II codes are: | CPT and HCPCS |
| Level I and Level II codes are used to: | Report outpatient services. |
| Modifiers | Helps explain something about a code. -LT left, -RT right,R=residence, H=hospital, etc. |
| If an ampule is opened and only half of the medicine is given you will... | Code for the entire ampule. There should also be notes stating that the rest of the medicine was wasted. |
Created by:
rjmtoss
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