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Under health ins
MEDICARE
| Question | Answer |
|---|---|
| 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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