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Health Insurance Chapter 14, 15

This begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days benefit period
May be used only once during a patient's lifetime and are usually reseved for use during the patient's final, terminal hospital stay (60 days) lifetime reserve days
Includes HMO's, PPO's, and PSO's though which a Medicare beneficiary may choose to receive health care coverage and services. Often provide a greater array of services and smaller copayment than conventional medicare coordinated care plan
A denial of otherwise covered services that were found to be not "reasonable and necessary" medical necessity denial
A plan that provides both medicare and medicaid coverage to certain eligible beneficiaries medicare-medicaid crossover
This helps individuals whose assets are not low enough to qualify them for medicaid by requiring states to pay their medicare part A and B premiums, deductibles, and coinsurance amounts qualified medicare beneficiary program (QMBP)
Helps low-income individuals by requiring states to pay their Medicare part B premiums qualifying individual (QI-1)
Helps individuals who received social security and medicare because of disability, but who lost their social security benefits and free medicare part A because they returned to work and their earnings exceeded the limit allowed. qualified disabled working individual (QDWI)
Enables Medicare beneficiaries to participate in mass PPV and influenza virus vaccination programs offered by public health clinics (PHC) and other entities that bill medicare carriers roster billing
Helps low-income individuals by requiring states to pay their medicare part B premiums specified low-income medicare beneficiary (SLMB)
Some medicare literature uses this term in place of benefit period; formerly called spell of sickness spell of illness
This reimburses institutional providers for inpatient, hospice, and some home health services medicare part A
This reimburses institutional providers for outpatient services and physicians for inpatient and office services medicare part B
What is another name for medicare part A medicare hospital insurance
What is another name for medicare part B medicare medical insurance
What is another name for medicare part C medicare advantage
What is another name for medicare part D medicare prescription durg plans
Formerly called Medicare+Choice, includes managed care and private fee-for-service plans that provided contracted care to medicare patients medicare part C
This adds prescription drug coverage to the original medicare plan, some medicare cost plans, some medicare private fee-for-service plans and medicare medical savings account plans medicare part D
Which is a federal program administered by CMS? medicare
Medicare Part___ reimburses institutional providers for inpatient, hospice, and some home health services part A
Which is a characteristic of Medicare enrollment eligible individuals are automatically enrolled, or they apply for coverage
A Medicare benefit period is defined as beginning the first day of hospitalization and ending when: the patient has been out of the hospital for 60 consecutive days
Skilled nursing facility (SNF) inpatients who meet medicare's qualified diagnosis and comprehensive treatment plan requirements when they are admitted after a 3-day minimum acute hospital stay are required to pay the medicare rate during which period? days 21-100
The original medicare plan is also called medicare: fee-for-service
Medigap coverage is offered to medicare beneficiaries by commercial payers
Which has been banned as a result of legislation passed by some states? balance billing
Which is a written document provided to a medicare beneficiary by a provider prior to rendering a service that is unlikely to be reimbursed by medicare advance beneficiary notice (ABN)
Individuals who are entitled to medicare and eligible for some type of medicaid benefit are called: dual eligibles
Annual income guidelines established by the federal government federal poverty level
Provides medical and health-related services to certain individuals and families with low incomes and limited resources (the medically indigent) medicaid
Sometimes called Medicaid eligibility verification system (MEVS) allows providers to electronically access the state's eligibility file recipient eligibility verification system (REVS)
This makes cash assistance available, for limited time, for children deprived of support because of a partent's absence, death, incapacity, or unemployment tempory assistnace for needy families (TANF)
This allows states to create or expand existing insurance programs and provides more federal funds to states for the purpose of expanding medicaid eligibility to include a greater number of children who are currently uninsured state childrens health insurance program (SCHIP)
Medicaid is jointly funded by federal and state governments, and each state: administers its own medicaid program
How often do state legislatures change medicaid eligibility requirements? during the year, sometimes more than once
Medicare Part A coverage is available to individuals under the age of 65 who: have a disability or end-stage renal disease
Temporary hospitalization of a patient for the purpose of providing relief from duty for the nonpaid primary caregiver of a patient is called______care: respite
Medicare Part B will cover some home health care services if the patient: is not eligible for medicare part A
The maximum fee a nonPAR may charge for a covered service is called the: limiting charge
Created by: kduvall20



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