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
IBC12
Medicare
| Question | Answer |
|---|---|
| What is the limiting charge? | % limit on fees that non par physicians may bill medicare above the allowed amount |
| Whatis an HMO cost plan? | beneficiaries receive medicare-covered services from sources in or outside the HMO network |
| What is an HMO risk plan? | when enrolled in HMO risk plan, they receive Medicare-covered services (except emergency, urgent need, and prior authorized services.) only from providers who are contracted members of the HMO network |
| What is respite care? | a short-term hospice inpatient stay for a terminally ill patient to give temporary relief to the person who regularly assists with home care of a patient |
| Why was Medicare started? | to provide coverage for the aged, retired, disabled individuals, and people who have chronic kidney disease |
| What does an I.D. card contain? | the wage earners SS# followed by an alpha letter along with effective dates |
| Who are medigap insurance benefits regulated by and what does it include? | regulated by the federal government (includes basic benefits) |
| What is the federal false claims amendment act created for? | to prevent overuse of services and spot medicare fraud |
| What do Stark I & II regulations guard against? | prohibit a physician who has a financial relationship to a family |
| When billing Medicare supplemental, when would you bill them? | secondary after primary has paid |
| What are non-benefit services? | foot care, routine care, eyecare |
| When a patient has medicare and medicaid what does medicaid pay? | the deductible, premium, and coinsurance |
| What is Medicare Part C? | Medicare Plus(+) Choice plans offer a number of health care options in addiction to those available under Part A & B. Plans may include health maintenance organizations, fee-for-service plans, provider-sponsored organizations, etc. |
| What is a benefit period? | begins the day a patient enters a hospital and ends when the patient has not been a bed patient in any facility for 60 days. Renewed every time patient begins new benefit period. No limit. Limits apply to hospice care. |
| What is correct coding initiative? | Federal legislation that attempts to eliminate unbundling or other inappropriate reporting or procedural codes for professional medical services rendered to patients |
| What is a fiscal intermediary? | insurance carrier that receives and processes claims from physicians and other suppliers of service for Medicare Part B |
| What is Medicare managed care? | Medicare enrollees have the right to join and assign their Medicare benefits to HMO's. The patient does not need a Medicare supplemental insurance plan |
| WHat does it mean when the letter precedes the insurance claim number on the I.D. card | Medicare RR recipient |
| What is the modifier when a waiver of liability is signed? | GA (MSP) |
| What does Medicare Part A cover? | hospital services |
| What does Medicare Part D cover? | prescription services |
| When does a patient not need A & B? | when they are covered under Medicare Part C |
| What levels of HCPCS does Medicare recognize? | levels I, II, & III |
| How is Medicare funded? | federally funded |
| What does Medicare Part B cover? | physician services |
Created by:
sanzijessica
Popular Medical sets