Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
MED112 Chapter 9
| Question | Answer |
|---|---|
| Medicare is a | Federal medical insurance program |
| Medicare was established | In 1965 under Social Security Act. |
| Medicare is Managed by | CMS |
| Four parts of Medicare | Part A, B, C, D |
| Part A | Inpatient benefits |
| Part B | Outpatient benefits |
| Part C | (Advantage—both A and B) |
| Part D | prescription drug benefits |
| Medicare is the | Most complex program that medical practices deal with |
| Medicare Part A (Hospital Insurance [HI]) | Program that pays for hospitalization, care in a skilled nursing facility, home healthcare, and hospice care |
| Medicare Part B (Supplementary Medical Insurance [SMI]) | program that pays for physician services, outpatient hospital services, durable medical equipment (DME), and other services and supplies |
| Medicare Part C | managed care health plans under the Medicare Advantage program |
| Medicare Part C is Available to | those who are eligible for Part A and enrolled in Part B |
| Medicare Modernization Act (MMA) | law with a number of Medicare changes, including a prescription drug benefit. |
| Medicare Part D | Medicare prescription drug reimbursement plans |
| Voluntary | most patients (“beneficiaries”) pay monthly premiums. |
| Part D as a separate plan is not needed if | a beneficiary is covered under a Medicare Advantage program that already includes drug coverage (such as a Medicare Advantage Plus Prescription Drug plan |
| Medicare card | Medicare insurance identification card received by each member. |
| Fiscal intermediary | government contractor that processes claims (sent by hospitals, etc., for Part A) |
| Carrier | health plan (processes claims sent by physicians, etc., for Part B) |
| Medicare administrative contractor (MAC) | contractor who handles claims and related functions (replaced fiscal intermediaries and carriers). |
| Screening service | or diabetes, HIV, etc.)—test or procedure performed for a patient with no symptoms, abnormal findings, or relevant history |
| Medicare Part B does not cover “excluded” services such as: | •Most routine examinations and custodial care. • Examinations for eyeglasses or hearing aids. • Some foot care procedures. • Services not ordered by a physician. |
| Medicare Part B does not cover “excluded” services such as: | • Cosmetic surgery. • Healthcare received while traveling outside the United States. • Procedures deemed not reasonable or medically necessary |
| Participating providers agree to | accept assignment for all Medicare claims and to accept Medicare’s fee as payment in full for services |
| PAR providers must | know the rules of the Medicare program. |
| Internet-Only Manuals | Medicare online manuals that offer day-to-day operating instructions |
| Medicare Learning Network (MLN) Matters | online collection of articles that explain all Medicare topics |
| Health Professional Shortage Area (HPSA) | geographic area offering participation bonuses to physicians |
| Quality Pay Program (QPP) | two-track value-based reimbursement system designed to incentivize high quality of care over service volume |
| Advance beneficiary notice of noncoverage (ABN) | form used to inform patients that a service is not likely to be reimbursed |
| Notifier | provider who completes the header on an ABN |
| Body | Blanks D–F |
| Options Box | Blank G |
| Additional Information | Blank H |
| Signature Box | Blanks I–J |
| Local coverage determination (LCD) | Decisions by M4ACs about the coding and medical necessity of a service |
| National coverage determination (NCD) | policy stating whether and under what circumstances a service is covered. |
| Limiting charge | highest fee nonparticipating physicians may charge for a particular service |
| Medicare Advantage (MA) | Medicare plans other than the Original Medicare Plan |
| Medicare Advantage offers three major types of plans | CCPs, MSAs Urgently Needed care |
| Medical Savings Accounts (MSAs) | Medicare health savings account program (similar to private medical savings account) |
Created by:
user-1990156