Health Insurance and Claims Chapter 14 & 15
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| what begins the first day of hospitalization and ends when the Medicare patient has been out of the hospital for 60 consecutive days | benefit period
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| This is also called a managaaed care plan. | coordinated care plan
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| Under Medicare A when all of the inpatient benefits have been exhausted the patient can choose to use all or some of their____________. | lifetime reserve days
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| What is it called when there is a denial of otherwise covered services that were found to be not "reasonable and necessary"? | medical necessity denial
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| This is a combination of two programs and it available to Medicare-eligible persons with incomes below the federal poverty level. | Medicare-Medicaid crossover
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| What are the four dual eligible Medicare beneficiary groups? | qualified Medicare beneficiary program (QMBP); qualifying individual (QI-1); qualified disabled working individual (QDW); Specified Low-income Medicare Beneficiary (SLMB)
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| What process does a Public Health Clinic or other entity use to bill for their mass vaccination program? | roster billing process
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| What is another term that can be used in place of benefit period? | spell of illness
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| What do you call an individual who is entitled to Medicare and eliglible for some type of Medicaid benefit? | dual eligibles
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| Income guidelines established annually by the federal government. | federal poverty level (FPL)
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| Cost-sharing program between the federal and state governments to provide health care services to low-income Americans. | Medicaid
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| What does a provider use to make sure a Medicaid patient has coverage on a specific date of service? | recipient eligibility verification system (REVS)
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| This program makes cash assistance available on a time-limited basis for children deprived of support because of a parent's death, incapacity, absence, or unemployment. | Temporary Assistance for Needy Families (TANF)
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| This was established to provide or expand health insurance coverage to uninsured children. | State Children's Health Ins. Program (SCHIP)
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| Medicare no longer uses the term explanation of Medicare benefits, now they use what? | Medicare Summary Notice
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| If you suspect that Medicare will deny services that you want for your Medicare patient what must you get them to sign? | Advance Beneficiary Notice (ABN)
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