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Terms in this set (22)
Pays a portion of patient's out of pocket costs
List 3 Scenarios that make Medicare primary
If you only have Medicare, If you have Medicaid, Tricare or COBRA
List 5 Scenarios that make Medicare secondary
If you have Automobile medical or no-fault insurance, end-stage renal disease program, federal black lung program, workers' compensation, Veterans Administration benefits, Coverage from a group health plan, Disability coverage from a group health plan
What does HCPCS stand for?
Healthcare Common Procedure Coding Systems
What is a nonphysician practitioner?
Nurse pratitioners, clinical nurse specialists, physician assistants. They are able to work as primary care providers
What did the Medicare Physician Fee Schedule (MPFS) used to be called?
Resource Based Relative Value Scale (RBRVS)
What is Medicare's benefit period?
First day of hospitalization until 60 consecutive days out of the hospital
Can NonPar Physicians accept assignment?
Only on a case to case basis
What is the deadline for filing claims?
December 31, unless dates of service are between Oct. 1 and Dec.31, then it is December 31 of the next year
Does Medicare cover experimental services?
What is an advance benificiary notice (ABN)?
It is a document signed when a service is unlikely to be covered by Medicare
What does Medicare Part D cover?
What is respite care?
Temporary hospitalization of a terminally ill hospice patient
What is the purpose of respite care?
To provide relief for the person taking care of the hospice patient
What does Medicare Part B cover?
Physician services, outpatient hospital care, physical and occupational therapy
What is Medicare Part C?
Health plan options that are approved by Medicare but managed by private companies
What is the general enrollment period for Medicare?
January 1 through March 31
What is the largest single medical benefits program in the US?
What does Medicare Part A cover?
Inpatient hospitalization, skilled nursing facility stays, hospice care, and some home health care
What is the general medicare elgibility?
Individual worked 10 years in Medicare-covered employment, 65 years old, permanent citizen of the US
What Act required an ambulance fee schedule?
The Balanced Budget Act of 1997
What is excluded from Inpatient Prospective Payment System (IPPS)?
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