MEDICARE

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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


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