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CH12&13 Study Packet

Medicare and Medicaid, Definitions, Acceptance of Assignment

Medicare Definition Is a Federally Funded Insurance Program.
Medicare Eligibility Requirements(5) 1Age 65 and is on SS 2Age 65 who have retired on railroad /civil service. 3An Individual that is disables. 4A person who has ESRD. 5A Kidney Donor
Medicare Enrollment Period A 3 month period before and after your DOB or the next January till March of the following year.
Medicare Benefit Period Begins the day a patient enters a hospital and ends when the patient has not been in a bed for 60 consecutive days (Hospital or Nursing Home Bed)
How many Parts are there in Medicare there are 4 (A,B,C,&D)
Medicare Part A This comes with Medicare. It is for Impatient Services for Hospice & Respite
Medicare Part B This comes with Medicare. It is for Outpatient Services-Claims for Physician Activities
Medicare Part C This is Managed Care Option. (This is optional)
Medicare Part D This is for the Prescription Drug Plan (This is optional)
Formulary Definition A list of Drugs that a health plan will cover
Hospice Care Definition An organization for the Terminally Ill for usually 6 months.
Respite Care Definition A short term stay for temporary releif to the person who is regularly assist with the home care.
Medicare/Medicaid An Old age survivor disability Ins Benefits-65 ans older, severity disables, and Blind
Medigap/Medifill Supplemental Insurance that one pays for in a fee-for-service plan-Helps cover the deductable, copays, and prescriptions.
Local Coverage Determination: A tool used in helping claim proccessing
A Medicare Card is generated on a yearly basis
What does the Letter at the end of the claim number on the Medicare Card mean? The Patient Status
Acceptance of Assignment Is where the physician agrees to ACCEPT payment from Medicare 80%, plus payment from the PATIENT, 20%, after the 155.00 annual deductable has been met.
Medicaid Eligibility (4) 1Based on income and Medically Needy 2Welfare recipients, poor children younger than 5 yrs of age. 3Low income Pregnant woman. 4Medically Indigent-Medical expenses that are high puts them below poverty line.
Medicaid Definition Jointly administered by the Federal Government and each State
Medicaid identification care is issues On a Monthly Basis
Created by: lorireid1980