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Under health ins

MEDICARE

QuestionAnswer
SPELL OF ILLNESS BENEFIT PERIOD
RESPITE CARE TEMPORARY HOSPITALIZATION OF PATIENT TO RELIEVE CAREGIVER
SURGICAL DISCLOSURE NOTICE USED BY NO PAR ELECTIVE SURGERY OVER $500.00
LIFETIME RESERVE DAYS "EXTRA" COVERED DAYS USED AT PATIENTS CHOICE
BENEFIT PERIOD FIRST DAY OF HOSPITALIZATION THROUGH 60 DAYS DISCHARGED
MEDICARE SELECT MEDIGAP THAT REQUIRES THE USE OF A NETWORK
DEMOSTRATION PROGRAM TESTING A CHANGE IN POLICY
MEDICARE PART D COVERS PRESCRIPTION COST
HOSPICE PALLIATIVE CARE FOR TERMINALLY ILL PATIENTS
MEDICARE PART C MEDICARE ALTERNATIVE FOR ADDITIONAL BENEFITS
MEDICARE PART B PAYS FOR OUTPATIENT AND PHYSICIAN SERVICES
MEDICARE PART A PAYS INPATIENT HOSPITAL, HOSPICE, HOME HEALTH, SNF
MEDIGAP MEDICARE SECONDARY POLICY, PAYS WHAT MEDICARE DOESN'T
SEP A SPECIAL TIME FOR A PERSON TO ENROLL DUE TO LIFE CIRCUMSTANCES
GEP JAN 1 - MAR 31 EACH YEAR
IEP STARTS 3 MONTHS BEFORE TURNING 65
10 YEARS HOW LONG YOU HAVE TO PAY TAXES INTO THE SYSTEM TO QUALIFY
DISEASE THAT QUALIFIES FOR MEDICARE (AUTOMATICALLY AT DIAGNOSIS) END STAGE RENAL DISEASE "ESRD"
REQUIREMENTS FOR MEDICARE AGE 65 OR DISABLED
LIMITING CHARGE MAXIMUM A NON - PAR CAN CHARGE
NON - PARTCIPATING DID NOT SIGN A CONTRACT WITH MEDICARE
MEDICARE CONDITIONALLY PRIMARY WHEN THE PRIMARY PAYER ISN'T PAYING
MEDICARE AS PRIMARY MEDICARE BEARS FIRST RESPONSIBILTY FOR PAYMENT
MEDICARE AS SECONDARY MEDICARE BEARS SECOND RESPONSIBILTY FOR PAYMENT
MSP MEDICARE SECONDARY PAYER
MSN MEDICARE SUMMARY NOTICE
MEDICARE SUMMARY NOTICE MONTHLY STATEMENT LIST CLAIM INFORMATION
MAC MEDICARE ADMINISTRATIVE CONTRACTORS
DEADLINE FOR CLAIMS ONE YEAR FROM DATE OF SERVICE
NON - PAR DID NOT SIGN A CONTRACT WITH MEDICARE
"ABN" SIGNED JUST IN CASE NON PARTICIPATING
EXPERIMENTAL PROCEDURES MEDICARE SECONDARY PAYER
PAR PARTICIPATING
BENEFIT FOR PARTICIPATINGS DIRECT PAYMENT 5% INCREASED PAYMENT
CAN BE A HMO OR MEDICARE ADVANTAGE OR OPTIONAL MEDICARE ALTERNATIVE MEDICARE PART C
PAYS FOR PHYSICIAN SERVICES AND PAYS FOR PHYSICAL OCCUPATIONA THERAPHY AND PAYS FOR OTPATIENT CARE MEDICARE PART B
PAYS FOR HOSPITALIZATION AND HOSPICE AND HOME HEALTH AND SKILLED NURSING FACILITIES MEDICARE PART A
HCPCS HEALTHCARE COMMON PRODECURE CODING SYSTEMT
DME DURABLE MEDICAL EQUIPMENT
DMEPOS DURABLE MEDICAL EQUIPMENT PROSTHETIC, ORTHOTICS
HCPCS LEVEL 1 CURRENT PROCEDURAL TERMINOLOGY ( CPT )
HCPCS II NATIONAL CODES
HCPCS LEVEL 1 IS FIVE DIGITS AND PUBLISHED BY AMERICAN MEDICAL ASSOCIATION
HCPCS LEVEL II NATIONAL CODES THEY ARE FIVE CHARACTERS AND START WITH A LETTER FROM A-V
5 TYPES OF HCPCS LEVEL II CODES 1. PERMANENT 2. DENTAL 3. MISC 4. TEMP. 5. MODIFIERS
PERMANENT CODES HCPCS NATIONAL PANEL WHICH IS COMPOSED BY REPS FROM BCBS, HEALTH INS. ASSOC (HIAA) AND (CMS) CENTER FOR MEDICARE AND MEDICAID SERVICES
DENTAL CODES CONTAIN IN CURRENT DENTAL TERMINOLOGY (CDT) PUBLISHED BY AMERICAN DENTAL ASSOCIATION
MISC CODES MISC./ NOT OTHERWISE CLASSIFIED CODES THAT ARE REPORTED WHEN A DMEPOS DEALER SUBMITS CLAIM FOR PRODUCT OR SERVICE WHICH THERE IS NO EXISTING HCPCS LEVEL II CODE - THEY CAN SUBMIT AS SOON AS FDA APPROVES
TEMP CODES MAINTAINED BY CMS (UPDATED EVERY 3 YEARS)
CATERGORIES OF TEMP CODES TRANSITIONAL PASS THRU PAYMENT OPPS (OUTPATIENT PROSPECTIVE PAYMENT SYSTEM)
MODIFIERS GET ATTACHED TO A CODE THEY ARE TWO DIGITS THAT GET ADDED TO END OF CODE (DESC OF SERVICE BEEN ALTERED)
D,G,M,P, OR F ARE REPORTED TO LOCAL MAC
B,E,K, OR L ARE REPORTED TO REGIONAL DME / MAC
A,J,Q, OR V REPORTED TO EITHER LOCAL MAC OR REGIONAL DME / MAC
Created by: wendyleppek
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