Medicare and reimbursement

Question 1

federal health care

Answer 1

medicare

Question 2

state health care

Answer 2

medicaid

Question 3

when participant buys health care plan that reimburses the provider

Answer 3

3rd party pay

Question 4

FFS

Answer 4

fee for service; scheduled, can be discounted, UCR, paid per visit, day, or episode

Question 5

UCR

Answer 5

usual, customary, reasonable; used to prove necessity of treatment

Question 6

DRG

Answer 6

Diagnoses related groups; set amount per problem

Question 7

what are the current problems with health care

Answer 7

1. rising cost
2. increased elderly population
3. longer lifespan + chronic illness

Question 8

describe benefit restrictions

Answer 8

limits #, type, and resources of visits per diagnoses

Question 9

how often do you pay co pay

Answer 9

every visit

Question 10

who is eligible for medicare

Answer 10

1. US citizens
2. 65 or older if contributed to social security for at least 10 years
3. spouse has met eployment retirement
4. certain conditions like ALS and end-stage renal disease

Question 11

insurance funded by state and gov’t, administered by state, and for the poor

Answer 11

medicaid

Question 12

what part of medicare includes hospital, hospice, home health, and SNF stay

Answer 12

part A

Question 13

how many days does medicare part A cover in hospital

Answer 13

90

Question 14

how many days does medicare part A cover in SNF

Answer 14

100

Question 15

what part of medicare includes MD services, Outpt hospital and therapy, ambulance, tests, and DME

Question 16

what does Part B partially cover

Answer 16

1. some preventative care
2. some meds
3. home health not covered in A

Question 17

Part of medicare that is voluntary, has a premium, and has a deductible,

Answer 17

Part B

Question 18

Part that covers medicare advantage

Answer 18

Part C

Question 19

Part that covers all meds

Answer 19

Part D

Question 20

what does medicare not cover

Answer 20

1. convenience items
2. assisted living
3. dental care
4. cosmetic care
5. hearing aids
6. eye exams or glasses
7. physical exams
8. foot care
9. care outside US