MEDICARE
SLMP
SPECIFIED LOW-INCOME MEDICARE BENEFICIARY
MEDICARE PART A
The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care.
MEDICARE PART B
The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies.
RESPITE CARE
a service that provides short-term relief or time off for persons providing home care to an ill, disabled, or frail older adult
WHAT IS INPATIENT PSYCHIATRIC PAYMENT PROSPECTIVE
FACILITIIES are paid per day according to drg's,wage -adjust rate and facility-level adjuster
WHY DO WE USE CODING MODIFERS
GIVES MORE INFORMATION ON SERVICE WHICH ISN'T IN REGULAR CODES
SLMP
HELPS LOW-INCOME INDIV BY REQUIRING STATES TO PAY MEDICARE B PREMIUMS
HCPCS
Healthcare Common Procedure Coding System
what does case mix mean
measures types of patient treatments which reflects utilization of level of healthcare
QMBP
QUALIFIED MEDICARE BENEFICIARY PROGRAM; INCOME NOT LOW ENOUGH TO QUALIFY FOR MEDICAID. REQUIRES THE STATE TO PAY PART A AND B PREMIUMS, DEDUCTIBLES AND COINSURANCE.
QI
QUALIFYING INDIVIDUAL WHICH HELPS LOW INCOME TO REQUIRE STATE TO PAY MEDICARE B PREMIUMS
WHAT ARE RUGS
Resource Utilization Groups PATIENT CLASSIFACTION SYSTEM FOR NURSING HOMES USED BY GOVT. IN SOME STATES TO DETERMINE REIMBURSTMENT LEVELS
OASIS STANDS FOR
outcomes and assessment information set USED IN HOME HEALTH SERVICES
WHAT DOES PER DIEM MEAN
payment to the provider per day
WHAT DOES HCPCS DO
provides codes of reporting services, procedures and supplies
QDWI
qualified disabled and working individual WHICH HELPS PPL WHO REC'D SS AND MEDICARE FOR DISABILITY LOSSES IT WHEN GOING BACK TO WORK REQUIRES STATE TO PAY MEDICARE A PREM
WHAT DOES MEDIGAP DO
supplements medicare benefits & pays for services medicare doesn't cover - ie. deductibles/coinsurance
WHAT IS BENEFIT PERIOD FOR HOSPICE
2@ 90DAYS 1 30DAY PERIOD 1 FINAL LIFETIME EXTENSION
WHEN IS MEDICARE GENERAL ENROLLMENT PERIOD
3 MONTHS PRIOR TO 65TH BIRTHDAY AND JAN 1 THRU MARCH31 OF EACH YEAR
WHAT IS THE MEDICARE LIMITING CHARGE FOR NON-PARS
5% BELOW THE PAR MEDICINE FEE SCHEDULE
WHAT ARE DRG
<Diagnostic Related Group> *set dollar payment on patient diagnostic and admission (i.e.*discharge early=hospital profit *late discharge=hospital loss).
WHAT IS AND WHEN IS AN ABN USED
ADVANCED BENEFICIARY NOTE USED WHEN A PROCEDURE MAY NOT BE COVER BY MEDICARE AND PATIENT IS ALERTED THEY MAY BE LIABLE FOR PAYMENT
WHAT IS CDT CODING
CURRENT DENTAL TERMINOLOGY WHICH IS KEPT UP BY ADA AND HAS IT'S OWN BOOK
HCPCS SECOND LEVEL IS
MAINTAINED BY HCPCS MADE OF A PANEL -BCBS,HIAA,SMS WHO REVISE, DELETE AND ADD CODES
WHAT ARE AMBULATORY SURGERY CENTERS
MEDICARE CERTIFIED SUPPLIER (NOT PROVIDER) OF SURGICAL HEALTHCARE AND IS SEPARATE FROM OTHER FACILITIES
WHAT IS A MEDICARE SUMMARY NOTICE
MONTHLY STATEMENT LISTING HEALTH INSURANCE CLAIMS INFO
WHAT IS OUTPATIENT PAYMENT PROSPECTIVE
DOESN'T COVER PROFESSIONAL SERVICES
WHEN IS MEDICARE SECONDARY INSURANCE
EMPLOYER PLAN OVER 20 PPL DISABILITY COVERAGE OVER 100PPL END STAGE RENAL DISEASE THIRD PARTY LIABILITY WORKMAN COMP VETERAN PRE AUTHORIZED SERVICES FEDERAL BLACK LUNG
WHEN IS MEDICARE A AVAILABLE AT NO COST
IF YOU OR YOUR SPOUSE HAS PAYED INTO MEDICARE FOR AT LEAST10YRS AND YOU ARE 65
WHAT DOES MEDICARE PART D COVER
It is the coverage for drugs for adults aged 65 or older
WHAT IS THE TIME LIMIT TO FILE MEDICARE CLAIM
ONE YEAR FROM DATE OF SERVICE
what is the difference between PAR and NON par providers
PAR IS CONTRACTED WITH FACILITIES NON PAR ISN'T
WHEN CAN BALANCE BILLING BE USED
PAR'S CAN'T USE WITH MEDICARE NON-PAR'S CAN WITHIN LIMITING COVERAGE
MEDICARE IS NEVER PRIMARY WHEN
VA END STAGE RENAL DISEASE
WHEN IS MEDICARE A PRIMARY INSURANCE
WHEN DROPPED FROM WORK INSURANCE WHEN GROUP INSURANCE IS NOT AVAILABLE AT WORK SELF-EMPLOYED COVERED BY TRI-CARE PATIENT IS UNDER 65 AND DISABLED PATIENT HAS MEDICARE-MEDICAID
WHAT IS ROSTER BILLING
WHEN SEVERAL PATIENTS ARE GETTING SAME VACCINATION AND ONLY ONE 1500 CLAIM FORM IS USED WITH AN ATTACHMENT OF PATIENTS NAMES AND INFO
WHEN CAN YOU USE CPT CODE AND HCPCS TOGETHER
WHEN SOME ONE IS GETTING A INJECTION OTHER THAN VACCINATIONS
WHEN DOES MEDICARE PAY FOR AMBULANCE SERVICE
When other means of transportation are contraindicated OR EMERGENCY
WHAT IS MEDICARE BENEFIT PERIOD
day 1 of hospitilization through 60 consecutive days following discharge