Medicare Part A

Réussis tes devoirs et examens dès maintenant avec Quizwiz!

Medicare Part A only pays for a total (lifetime limit) of

190 days of inpatient care in a Medicare certified psychiatric facility

Medicare Part A hospital and skilled nursing facility benefits are paid on the basis of

Benefit Periods

Short-term inpatient care is

Covered services for Hospice Care

Medicare covers home health services for

as long as needed

Medicare will cover all

but the first 3 pints of blood

Although Medicare does not cover prescription drugs as part of

Home health care

People of all ages who are terminally ill can get

Hospice care

If doctor decides medical care at home is needed, and makes a plan for care at home; only then

Medicare will cover health care

Skilled care is health care given when the patient needs skilled a nursing or rehabilitation staff to manage, observe, and evaluate care, when given in a

Medicare-certified SNF

If the beneficiary does not have medicare part A then will he be covered by SNF

NO

the patient's cost in Original Medicare for home health care services is

$0

The coinsurance rate for days 21 through 100 in a skilled nursing facility is

$176

For days 61 through 90 of hospitalization in a benefit period, Medicare Part A will pay all covered expenses after the patient pays a daily copayment amount that changes annually. Beneficiaries must pay an additional

$352

Medicare pays all cost for days

1 through 20 days

Medicare covers certain skilled care services that are needed daily on a short-term basis up to

100 days

the patient's cost in Original Medicare for durable medical equipment is

20%

Medicare does NOT cover

24-hour-a-day care at home; Meals delivered to a home; Homemaker services like shopping, cleaning and laundry; or Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care needed

What are the qualifying days to be in a hospital to cover the SNF

3 consecutive days

The benefit period ends when the patient has not been in a SNF or a hospital for at least

30 days

The patient must enter the SNF (Skilled Nursing Facility) within

30 days

The patient can get hospice care as long as the doctor and the hospice medical director or other hospice doctor certifies that the patient is terminally ill and probably has

6 months or less to live

Medicare will pay all charges for covered hospital services during the first

60 days of a benefit period except for a deductible

Medicare defines part-time or intermittent as skilled nursing or home health aide services combined to total less than

8 hrs per day and 28 or fewer hrs each week. Based on the need for care, on a case-by-case basis, the weekly total may be increased up to 35 hours

The Medicare Summary Notice is also referred to as an

Explanation of Medicare Benefits (EOMB or EOB)

Hospice care is available under Medicare only if the patient meets the following requirements:

Is eligible for Medicare Hospital Insurance (Part A); Signs a statement choosing hospice care instead of standard Medicare benefits for the terminal illness; Receives care from a Medicare-approved hospice program; and The patient's doctor and the hospice medical director certify that the patient is terminally ill with 6 months or less to live if the disease runs its expected course

Medicare Part A providers are required to file a claim with a

Medicare Intermediary

The patient is responsible only for the following

No more than $5 for each prescription drug and other similar products. The hospice can charge up to $5 for each prescription, outpatient drugs, or other similar products for pain relief and symptom control. 5% of the Medicare payment amount for inpatient respite care

Patients who get health care from a Medicare Advantage Plan must get at least the same coverage as the

Original Medicare Plan

changing sterile dressings, intravenous injections and physical therapy are examples of

Skilled Care

Semi-private room; Meals; Skilled nursing care; Physical therapy*; Occupational therapy*; Speech-language therapy*; Medical social services; Medications; Medical supplies and equipment used in the facility;

Skilled Nursing Facility

Home Health Care is

Skilled care is skilled nursing care and certain other health care services the patient receives at home for treatment of an illness or injury

getting in and out of bed, eating, dressing, and using the bathroom are the examples of

custodial care

Medicare does not cover

custodial care, if that is the only kind of care needed

If the patient lives longer than 6 months, the patient can still get hospice care, as long as the hospice medical director or other hospice

doctor recertifies

The patient pays for the

first 3 pints of blood

What are the lifetime reserve days in Medicare

from days 91 to 150 days

Families of people who are terminally ill may also benefit from

hospice care and can receive counseling services

Hospice care for people who are terminally ill includes

physical, psychological, social, and counseling services

s. In 2006, a prescription drug benefit was added to Medicare that pays some, but not all

prescription drug costs under home health care

Inpatient hospital care does NOT include

private-duty nursing, a phone or a television in the patient's room, or personal care items, such as razors or clipper socks

Medicare covered hospital services

include a semiprivate room, meals, general nursing, drugs as part of inpatient treatment, and other hospital services and supplies

Medicare Part A, days 1 to 60 are

inexhaustible

Respite care

is care given to a hospice patient by another caregiver so that the usual caregiver can rest

Rehabilitation care is used to help improve a condition within a given time period, or set up a

maintenance program

Medicare covers inpatient

mental health care services

First-dollar coverage means there is

no deductible

Is private room covered by Medicare

no, only in special circumstances

the skilled nursing care and home health aide services are only covered on a

part time or intermittent basis

Medicare pays all cost for

r home health care visits

Registered nurses, Licensed Physician, Physical therapist, speech-pathology and audiologist are under

skilled care

Hospice is a special way of caring for people who are

terminally ill

Ambulance transportation will be covered

unless arranged by the hospice medical team

Care in an emergency room or an inpatient facility will be covered

unless arranged by the hospice medical team

The patient is homebound,

which means the patient is normally unable to leave home or that leaving home is a major effort. When the patient leaves home, it is only for a short time and not very frequently (for example, to attend religious services or to get medical treatment

If Billy went to hospital and on July 1st 2020 and left hospital on July 15th 2020, and re-entered the hospital for same reason on Aug 1st 2020, will he be covered and how many times he has to Part A deductible.

yes, one time $1408


Ensembles d'études connexes

Words (with roots) of the Quran - 99/99

View Set

URINARY DISORDERS (PREVIOUS EXAM)

View Set

Operations Management Chapter 7 Process Strategy + 7S

View Set

Insurance Regulations, Basics, and general

View Set

24.14-24.15 Digestion and Absorption. Aging

View Set

TExES Core Subjects EC-6 (291): Science

View Set