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 |