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AR Chapter 12
Medicaid
| Question | Answer |
|---|---|
| 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
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