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is a federal medical expense insurance program for people age 65 and older and even if the individual continues to work.
__________ are also available to anyone, regardless of age, who has been entitle to Social Security disability income benefits for 2 years or has chronic kidney disease.
____________ is administered by the Center of Medicare and Medicaid Services, which is a division of the USA Department of Health and Human Services.
What are the 4 distinct parts of Medicare?
- 1.Part A, Hospital Insurance-
- is financed through a portion of the payroll tax (FICA).
- 2.Part B, Medical Insurance-
- is financed from monthly premiums paid by insureds and from the general revenues of the federal government.
- 3.Part C,
- allows people to receive all their health care services through available provider organizations.
- 4.Part D,is for prescription drug coverage.
________ is the amount a physician or supplier actually bills for a particular service or supply.
_____________ Care that is provided at an ambulatory center. These are surgical services performed at a center that do not require a hospital stay unlike in-patient hospital surgery.
Ambulatory Surgical Services
________ the amount Medicare determines to be reasonable for a service that is covered under Part B of Medicare.
___________ The physician or a medical supplier agrees to accept the Medicare approved amount as full payment for the covered services.
______ organizations that process claims that are submitted by doctors and suppliers under Medicare.
_____________ Outpatient services received from a Medicare participating comprehensive outpatient rehabilitation facility.
Comprehensive outpatient rehabilitation facility Services
_______ The amount of expense a beneficiary must first incur before Medicare begins payment for covered services.
______ Medical equipment such as oxygen equipment, wheel chairs, and other medically necessary equipment that a doctor prescribes for use in the home.
Durable Medica Equipment
__________ the difference between the Medicare approved amount for a service or supply and the actual charge.
___________ organizatiosn that process inpatient and outpatient claims on individuals by hospitals, skilled nursing facilities, home health agencies, hospices and certain other providers of health services.
__________ The Maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does nt accept assignment.
__________ Doctors or suppliers who may choose whether or not to accept assignment on each individual claim.
_______ Medically necessary outpatient physical and occupational therapy or speech pathology services prescribed by a doctor or therapist.
Outpatient Pysical and Ouccupational Therapy and Speech Pathology Services
______ Provides for a pap smear to screen for cervical cancer once every 2 years.
Pap Smear Screening
________ a program of outpatient mental health care
Partial Hospitalization for Mental Health Treatment
___________ Doctors and suppliers who sign agreements to become Medicare participating. For example, they have agreed in advance to accept assignment on all Medicare claims.
Participating Doctor or Suppliers
________ Groups of practicing doctors and other health care professionals who are paid who are paid by the government to review the care given to Medicare patients.
Peer review organizations
_______ is when an individual first becomes eligible for Medicare (starting 3 months before turning age 65, ending 3 months after the 65th birthday)
Initial enrollment period
______________ between January 1st and March 31st each year.
General enrollment period
____________ if the individual or his/her spouse is employed and covered under a group health plan
Special Enrollment period
Under what hospital stay, does NOT include private duty nursing, a television or telephone in your room .(Part A)
inpatient hospital stay
What is the number of days can the inpatient hospital benefit start a new benenfit period and new deductible?
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