Medicare
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each of the black spaces below before clicking
on it to display the answer.
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| accountable care organizations (ACOs) | show 🗑
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| show | document that acknowledges patient responsibility for payment if Medicare denies the claim.
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| show | begins with the first day of inpatient hospitalization and ends when the Medicare patient has been out of the hospital for 60 consecutive days.
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| conditional primary payer status | show 🗑
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| show | special project that tests improvements in Medicare coverage, payment, and quality of care.
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| show | CMS model implemented for Medicare risk-adjustment purposes and results in more accurate predictions of medical costs for Medicare Advantage enrollees; its purpose is to promote fair payments to managed care organizations that reward efficiency and encour
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| show | list of brand name and generic prescription drugs covered by a health plan.
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| employer-sponsored group health plan (EGHP) | show 🗑
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| show | enrollment period for Medicare Part A and Part B held January 1 through March 31 of each year.
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| show | seven-month period prior to turning age 65 that provides an opportunity for the individual to enroll in Medicare Part A and Part B.
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| show | may be used only once during a patient’s lifetime and are usually reserved for use during the patient’s final, terminal hospital stay.
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| show | traditional Medicare-enrolled provider/supplier or a non-traditional provider that offers influenza virus and/or pneumococcal vaccinations to a large number of individuals.
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| medical necessity denial | show 🗑
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| show | federal health insurance program, authorized by Congress and administered by CMS, for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease (ESRD).
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| Medicare Advantage | show 🗑
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| show | replaces SSN as health insurance claim number on new Medicare cards for transactions such as billing, eligibility status, and claim status.
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| show | type of Medicare health plan available in certain areas of the country, which works similarly to a Medicare Advantage plan; if the beneficiary receives health care services from a non-network provider
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| Medicare Hospital Insurance | show 🗑
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| show | combination of Medicare and Medicaid programs available to Medicare-eligible persons with incomes below the federal poverty level.
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| show | helps cover physician and other qualified health care practitioner services, outpatient care, durable medical equipment, and preventive services; the CMS-1500 claim is submitted for services.
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| Medicare medical savings account (MSA) | show 🗑
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| show | standardized notice provided to Medicare beneficiaries that they are outpatients receiving observation services and are not inpatients of a hospital or a critical access hospital (CAH).
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| show | helps cover inpatient hospital care, skilled nursing facility care, hospice care, and home health care; the UB-04 (CMS-1450) claim is submitted for services.
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| show | helps cover physician and other qualified health care practitioner services, outpatient care, durable medical equipment, and preventive services; the CMS-1500 claim is submitted for services.
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| Medicare Part C | show 🗑
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| Medicare Part D | show 🗑
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| Medicare Part D coverage gap | show 🗑
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| show | see Medicare Part D coverage gap.
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| show | organization (e.g., health insurance company) that has one or more contract(s) with CMS to provide Part D benefits to Medicare beneficiaries.
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| Medicare private contract | show 🗑
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| Medicare Savings Program (MSP) | show 🗑
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| Medicare Secondary Payer (MSP) | show 🗑
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| Medicare SELECT | show 🗑
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| show | mandated by the Patient Protection and Portable Care Act (PPACA) to facilitate coordination and cooperation among providers to improve quality of care for Medicare fee-for-service beneficiaries
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| show | covers Medicare Part?A and/or Part B health care for individuals who can benefit the most from special care for chronic illnesses, care management of multiple diseases, and focused care management
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| show | available to Medicare beneficiaries who participate in a drug plan so they can learn how to manage medications through a free Medication Therapy Management (MTM) program
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| show | supplemental plans designed by the federal government but sold by private commercial insurance companies to cover the costs of Medicare deductibles, copayments, and coinsurance, which are considered “gaps” in Medicare coverage.
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| show | provider who does not accept Medicare and has signed an agreement to be excluded from the Medicare program.
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| private fee-for-service (PFFS) | show 🗑
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| Programs of All-inclusive Care for the Elderly (PACE) | show 🗑
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| risk adjustment | show 🗑
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| show | process of verifying that diagnosis codes submitted for payment by a Medicare Advantage organization are supported by patient record documentation for an enrollee.
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| roster billing | show 🗑
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| show | enrollment in Medicare Part A and Part B available outside of the general enrollment period due to special circumstances, such as individuals covered by a group health plan based on current employment
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| spell of illness | show 🗑
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Created by:
Amaya122000