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FLAVIN MOS150U3

Terminology

QuestionAnswer
Part _____ of Medicare helps pay for physician and outpatient charges. B
A private insurance company that serves as the federal government’s agent in the administration of the Medicare program, including the payment of claims, is a Medicare administrative contractor
Medicaid allows private individuals (or their families) to deplete their finances to the point where the individual or family becomes eligible for Medicaid assistance. This is called spend down
Fees that Medicare permits for a particular procedure, service, or supply are called allowable fees
Medically needy individuals can reduce their assets to the Medicaid eligibility level by deducting medical expenses; this is called a/an spend down
When a Medicaid beneficiary has no other healthcare coverage, the type of claim to be submitted is called a _____ claim. Medicaid simple
A physician, practitioner, facility, or supplier with fewer than 10 FTE employees is considered a PAR provider
A state option that provides individuals with disabilities who are eligible for nursing homes and other institutional settings with options to receive community-based services is called a/an community first choice option
The act that provides for a federal system of old age, survivors, disability, and hospital insurance is the Federal Insurance Contribution Act (FICA)
A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is Medicare
The legal obligation of other insuring entities to pay all or part of the healthcare expenses of a Medicaid beneficiary is called third-party liability
A commercial insurer contracted by the HHS for the purpose of processing and administering Medicaid claims is called a Medicaid contractor
Individuals who receive medical assistance because their income falls within the poverty or FPL guidelines or as a result of SSI eligibility are considered categorically needy
The acronym for the program that provides comprehensive alternative care for noninstitutionalized elderly persons who otherwise would be in a nursing home is PACE
A combination federal/state medical assistance program that provides comprehensive and quality medical care for certain categories of low-income and qualifying elderly people is Medicaid
Every time a claim is sent to Medicaid, a document is generated explaining how the claim was adjudicated, or how the payment was determined, which is called a/an remittance advice
Part _____ of Medicare includes Medicare advantage options. C
An individual who has health insurance coverage through both the Medicare and Medicaid programs is commonly referred to as a beneficiary
Part _____ of Medicare helps pay for charges incurred during an inpatient hospital stay. A
Part _____ of Medicare helps pay for prescription drugs. D
When one state allows Medicaid beneficiaries to be treated in an adjacent state, it is referred to as reciprocity
When a Medicare claim is filed, the beneficiary receives a document explaining the claim adjudication called a/an MSN
An individual who is eligible for both Medicare and Medicaid programs is said to be a/an dual eligible
When a healthcare provider engages in intentional misrepresentation or deception that could result in an unauthorized benefit to an individual, it is called fraud
The duration of time during which a Medicare beneficiary is eligible for Part A benefits for inpatient hospital or skilled nursing facility charges is called a/an benefit period
Created by: Iteach4Docs
 

 



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