Medicare Insurance

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Medicare Part A is run by

the center for Medicare and Medicaid Services

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The letters preceding the number on the patient's Medicare identification card indicate

railroad retiree.

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Part A of Medicare covers

hospice care.

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medicare Part A benefit period ends when a patient

has not been a bed patient in any ospital or nursing facility for 60 consecutive days.

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The Part B Medicare annual deductible is

$100

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The frequency of Pap tests that may be billed for a Medicare patient who is not at risk is

once every 3 years

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Medigap insurance may cover

the deductible not covered under Medicare.

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When a Medicare beneficiary is still working and has employer supplemental coverage, Medicare refers to these plans as

MSP.

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If you were processing a claim for MSP, Medicare would always be billed

second.

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Some senior HMOs may provide services not covered by Medicare, such as

eyeglasses and prescription drugs.

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Stark I and II regulations

prohibit the referral of a Medicare or Medicaid patient to a laboratory or other outside provider/facility in which the physician has a financial relationship.

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A participating physician with the Medicare plan agrees to accept

80% of the Medicare-approved charge.

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In the Medicare program, there is mandatory assignment for

Clinical laboratory tests.

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A medicare prepayment screen

Both A and B

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When a Medicare patient signs an advance beneficiary notice, the procedure code or the service provided must be modified using the HCPCS Level II modifier

-GA

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Under the prospective payment system (PPS), hospitals treating Medicare patients are reimbursed according to

preestablished rates for each type of illness treated based on diagnosis.

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Payments to hospitals for Medicare services are classified according to

DRGs.

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The 1987 Omnibus Budget Reconciliation Act (OBRA) established the

MAAC.

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RBRVS was established as a means to

redistribute Medicare dollars among physicians more equitably.

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RBRVS consists of a/an

All of the above

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The HCPCS national alphanumeric codes are referred to as

Level II codes.

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When a Medicare carrier transmits a Medigap claim electronically to the Medigap carrier, it is referred to as a/an

crossover claim.

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An explanation of benefits document for a patient under the Medicare program is referred to as the

Medicare remittance advice document.

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A claims assistance professional (CAP)

may act on the Medicare benefiniary's behalf as a client representative.

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If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist should

deposit the check and then write to Medicare notifying them of the overpayment.

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Created by: bunnyfinley