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AR Chapter 12


physician services medicare part B
medicare administered by the CMS and is a federally funded program
medicare started to provide coverage for the aged, retired, disabled individuals, and people with chronic kidney disease
medicaid may pay for (when a patient has medicare and medicaid) the deductible, premium, and coinsurance
ID card contains wage earners SSN, followed by an alpha letter, along with the effective dates
medicare part C medicare's HMO plan, patient does not need part A or part B if they have this
medigap insurance are regulated by the federal government and include basic benefits
medicare secondary payer (MSP) bill medicare secondary
stark I & II regulations prohibit physician who has a financial relationship with a designated health service from referring patients to the facility (finanal interest)
federal false claims act federal law to prevent overuse of services and to spot medicare fraud
modifier used when a waiver of liability is signed -GA
medicare coding claims HCPCS level I, II, & III
limiting charge percentage limit that a nonpar physician may bill medicare over the allowed amount
T/F - letters that precedes the insurance claim number on the ID card indicate a disabled person F (answer railroad retiree)
T/F - medicare non benifits include routine physical exams, foot care, eye or hearing exams, and cosmetic surgery T
respite care inpatient stay provided for terminally ill to give temporary relief to the patients caregiver
fiscal intermediary organization under contract with government that handles claims under medicare part A & B
benefit period (hospitalization)when patient enters hospital and is discharged and not readmitted for 60 days
medicare part A hospital coverage
correct coding initiative (CCI) implemented by CMS to eliminate unbundling
medicare part B supplementary medical insurance (physician services)
HMO risk plan medicare restricted beneficiaries that receive services from contracted providers and facilities
medicare part C receives fixed amount of money from Medicare to spend on their member (HMO)
HMO cost plan medicare beneficaries receive services from sources outside the HMO network
medicare managed care senior HMO
Created by: maxphia32