MEDICARE / BILLING CH 4 Flashcards
(27 cards)
Which is covered by Medicare A?
1. Any out patient bills
2. All medically necessary outpatient
3. All medically necessary inpatient after 24 hrs in SNF only
4. All medically necessary inpatient SNF after 48 hours / 3 days hospital, home health, or hospice stay.
4 covers medically necessary inpatient hospitalization, in a SNF FOLLOWING a 3 DAY hospital stay, home health care, and hospice.
What is NOT covered by Medicare B?
- Some Outpatient Dr. visits
- Some Inpatient hospital care
- All medical services not covered by Part A
- Rehab therapy
- All non covered home health services
Is it a mandatory program?
- Some Outpatient Hospital care
- Some other medical services that Part A does not cover
- B covers approximately 80% Rehab services one minute necessary 
- Only covers some home health care, assist for those covered services & supplies when medically necessary
No -B is Voluntary with mthly premium
When is a beneficiary eligible for Plan B?
1. On the month they turn 65
2. within 6 month period beginning 1 month before 65th birthday
3. within 7 month period beginning 3 months before 65th birthday
4. Anytime if a US citizen
4 Within 7 month period beginning 3 months before 65th birthday
What is not true of by Medicare C?
- Has monthly Premium
- The Private insurance companies do not need to be approved by Medicare to become a Supplement provider.
- These Private insurance companies are paid a % of the Services provided
- These plans must follow minimal rules set by Medicaid.
- Payment received for services will always be less than the traditional Medicare.
Medicare Part C, also known as Medicare Advantage or a Replacement Plan, is a replacement for traditional Medicare. (A & B)
- Is managed care coverage provided by private insurance companies APPROVED by Medicare.
- NO, private insurance companies are paid a FIXED amount each month.
- These plans must follow the minimal rules set by MEDICARE.
- Depending on if the provider is contracted with the payer, the payment received may be MORE, LESS or EQUAL to the traditional Medicare.
Which are part of the Medicare Advantage Plan types?
1. Health Maintenance Organization HMO
2. Preferred Provider Organization PPO
3. Private Fee-For Services Plan
4. Special Needs Plan
5. Medical Savings Accounts MSA’s
6 All of the Above
7 A and B
6 All are Advantage Plan types
What is covered by Medicare D?
- Drug Coverage
- Dr. Visits
- Rehab services
- Medicare Part D, Prescription Drug plan, covers medication
These are subject to annual deductible
Is Medigap also know as Medicare Supplement insurance?
True A Medigap policy (also known as Medicare supplemental insurance) is
.
Works only with the Original Medicare Plan. If one joins Medicare Advantage plan the gam will not pau any deductibles, copays or other cost-share under the Medicare plan
Medigap is a health insurance sold by the government to fill in the gap’s, under the original Medicare plan , in coverage such as
Coinsurance,
deductibles
copays
True or false
False
Medigap is health insurance sold by PRIVATE INSURANCE companies to fill in the “gaps” in coverage (like deductibles, coinsurance, and copayments) under the Original Medicare Plan
Which plan Is also known as Medicare Advantage or Replacement Plan
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap`
3 - Medicare C
Which plan Covers Medicare deductibles, coinsurance, and copayments
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap
5 - Medigap
Which plan Allows sign-ups anytime within the seven-month period that begins three months before turning 65
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap
2 - Medicare B
Which plan Covers medically necessary inpatient hospitalization, care in a SNF following a three-day hospital stay, home health care, and hospice
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap
1 - Medicare A
Which plan is related to the term “dual eligible” (select all that apply.)
1 - Medicare A & B
2 - Medicare C
3 - Medicare D
4 - Medigap
5 - Medicaid
1 - Medicare A & B
5 - Medicaid
Which plan helps pay for medically necessary doctor services, outpatient hospital care, physical and occupational therapists, and some home health care
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap
2 - Medicare B
Which plan requires a blood deductible that is currently 3 pints per year (unless the patient or someone else donates to replace it)
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap
1 - Medicare A
2 - Medicare B
Which plan covers medication and is subject to an annual deductible
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap
4 - Medicare D
Which plans works only with the Original Medicare Plan (select all that apply)
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap
5 - Medigap
Which plan helps pay for ambulance services (when other transportation would endanger health) and kidney dialysis
1 - Medicare A
2 - Medicare B
3 - Medicare C
4 - Medicare D
5 - Medigap
2 - Medicare B
Which plan Is part of a federal-state partnership
1 - Medicare A & B
2 - Medicare C
3 - TRICARE
4 - Medicaid
5 - CHIP
4 - Medicaid
Requires an NAS before any non-emergent inpatient
1 - Medicare A & B
2 - Medicare C
3 - TRICARE
4 - Medicaid
5 - CHIP
3 - TRICARE
Self insured is the term for non-coverage patient?
True or False
FALSE
Self pay
Self Pay is the term for coverage that puts premium payments into a fund to cover services and pay a third party to administer benefits from the fund
True or False
False
Self-Insured
ERISA regulates Self Insured health plans.
True or False
True
Employee Retirement Income Security Act
Self Insured plans may not have to follow the state timely payment regulations unless the state statue specifically state that ERISA plans are included.
True or False
True
