Billing Flashcards
Title XVIII of the Social Security Act (SSA) is also known as…..
Medicare
The 4 qualifiers for Medicare are….
-elderly (65+)
-permanent disability
-end stage renal disease (ESRD)
-Lou Gehrig’s disease
I’m The 4 parts of Medicare are…
Part A
Part B
Part C
Part D
MDCR Part A covers_______
MDCR Part B covers_______
MDCR Part C covers_______
MDCR Part D covers_______
A - Inpatient hospital stays
B - Medical (review chart)
C - advantage or replacement
D - Drugs
5 types of Medicare Advantage plans
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- Private Fee-for-service plans
- Special needs plans
- Medical Savings Accounts (MSAs)
MDCR advantage plan in which members must generally get healthcare from providers in the plan’s network is aka ______
HMO
MDCR advantage plan in which members can see any doctor or provider that accepts Medicare and don’t need a referral for specialist is aka______
PPO
MDCR advantage plan that allows members to go to any provider that accepts the plans terms is aka _______
Fee-for-service
MDCR advantage plan, which are limited to people in long-term care facilities (that are eligible for MDCR) and is only available in limited areas is aka _____
Special needs plans
MDCR advantage plan with two parts, a high deductible, plan, and an account Medicare deposits, money into is aka _______
Medical Savings Accounts (MSAs)
What is a formulary?
A list of medicare cover drugs
Private firms that process Medicare claims, enroll providers, provide education on billing requests, and answer provider and patient questions are also aka _____
Medicare administrative contractor (MAC)
DME stands for_______
Durable medical equipment
What are the advantages of the Medicare participating physician program?
-higher fee schedule payments
-fewer collection efforts
-publicity
-Government approval to display Medicare emblems
Are workers compensation regulations determined by the state or federal government?
State