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CH12&13 Study Packet
Medicare and Medicaid, Definitions, Acceptance of Assignment
| Question | Answer |
|---|---|
| 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
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