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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