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Chapter 17 test

Terms in this set (25)

When a pt has Tricare for Life and Medicare, who is the primary payer? Who is the secondary payer?
Medicare and Tricare is secondary
Pt's over 65 with Tricare for Life can seek medical services at which facilities?
Medical hospital, clinic, military VA, and private clinic
What is Medigap and is it a part of Medicare's RBRVS?
A secondary insurance and is not apart of RBRVS
List the guidelines to apply with Medicaids Pt's
Retired, low income, disadvantage, active or retired military personnel and their families
Can a physician bill a Medicaid pt that services billed and Medicaid did not pay for?
Yes
How much does Medicare pay the physician after the annual deductible is met?
80%
What is respite care?
Temporary care for terminally ill or elderly Pt's to give usual care givers a break
Is respite care covered by Medicare?
Yes
What is hospice?
Organization that provides comfort care including pain relief for terminal Pt's and their families
What are the characteristics of Medicaid?
Health cost assistance program, federal funds for mandated services
Who is entitled to Medicare?
If you are older than 65 with social security or if you are under 65 you apply for blindness, widowed, extreme disability, and kidney failure
What part of Medicare covers hospitalization up to 90 days?
Part A
When a Medicare pt goes to a hospital, when does benefit period begin and end?
Days the pt enter to 60 days after release
How can a Pt be covered under Medicare part B?
You have to apply, not automatic
Review allowed benefits
Insurance claim department compares the fee the doctor charges with the benefits provided by the patients health plan
Explain patient liability
What the patient owes after the insurance company has paid
When are insurance claims filed?
Claims must be submitted within a few business days of the visit
Why would a claim be denied by the insurance company?
If the therapy is not medically necessary based on the diagnosis
Deductible
Fixed dollar amount that must be paid by the insured for charged provided met once a year
Copayment
Fixed fee collected at the time of visit, collected at the beginning
Subscriber
Policyholder
Premium
Charge for keeping insurance policy in affect
Who most frequently files insurance claims and handles payments
Medical assistant
What is the assignment of benefits?
Document signed by the Pt's following the physician to bill the insurance, recieve payments directly, and accept payers allowed changes
What is Medicare?
Largest federal program that covers Pt's over 65 or under with certain circumstances
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