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Health Insurance
HI chp 14-15
| Question | Answer |
|---|---|
| What part of Medicare pays for inpatient hospital critical care access; skilled nursing facility stays; hospice care; and some home health care? | Medicare Part A |
| What part of Medicare pays for doctors' services; outpatient hospital care; DME; and some medical services that are not covered by Part A? | Medicare Part B |
| What part of Medicare was formerly called Medicare+Choice, includes managed care and private fee-for-service plans that provide contracted care to Medicare patients? | Medicare Part C |
| What part of Medicare adds prescription drug coverage to the Original Medicare Plan? | Medicare Part D |
| What is the standard method for providers to obtain Medicare eligibility information? | Electronic Data Interchange |
| What begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days? | Benefit Period |
| How many Lifetime Reserve Days are Medicare patients allowed? | Sixty |
| What do patients need to become inpatients at a SNF after an acute hospital stay? | Three-day-minimum stay |
| What is an autonomous, centrally administered program of coordinated inpatient and outpatient palliative services for terminally ill patients and their families? | Hospice |
| What is another name for a physician fee schedule? | RBRVS |
| What program combines medical, social and long-term care services for frail people who live and receive health care in the community? | PACE |
| What is the maximum fee for a nonPAR that may be charged for a covered service? | Limiting Charge |
| What is a written document provided to a Medicare beneficiary by a supplier, physician, or provider prior to service being rendered? | Advance Beneficiary Notice |
| What is an easy-to-read monthly statement that clearly lists health insurance claims information for Medicare beneficiaries? | Medicare Summary Notice |
| What was developed to enable Medicare beneficiaries to participate in mass PPV and influenza virus vaccination programs offered by public health clinics and other entities that bill Medicare payers? | Roster Billing |
| What is forbidden as the result of legislation passed by some states? | Balance Billing |
| What four programs are dual eligible? | QMB, QWDI, QI, and SLMB |
| What allows states to create or expand existing insurance programs, providing more federal funds to states for the purpose of expanding Medicaid eligibility to include a greater number of currently uninsured children? | SCHIP |
| If the Medicare beneficiary has Medicare for its primary insurance, what do you need to type into box 11 on the CMS-1500 claim? | None |
Created by:
YTIMBC
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