Review

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Author:
dbawinsett01
ID:
26900
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Review
Updated:
2010-07-15 13:46:52
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Social Insurance
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review
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  1. is a federal medical expense insurance program for people age 65 and older and even if the individual continues to work.
    Medicare
  2. __________ 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.
    Medicare benifits
  3. ____________ is administered by the Center of Medicare and Medicaid Services, which is a division of the USA Department of Health and Human Services.
    Medicare
  4. 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.
  5. ________ is the amount a physician or supplier actually bills for a particular service or supply.
    actual charge
  6. _____________ 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
  7. ________ the amount Medicare determines to be reasonable for a service that is covered under Part B of Medicare.
    Approved amount.
  8. ___________ The physician or a medical supplier agrees to accept the Medicare approved amount as full payment for the covered services.
    assignment
  9. ______ organizations that process claims that are submitted by doctors and suppliers under Medicare.
    Carrieres
  10. _____________ Outpatient services received from a Medicare participating comprehensive outpatient rehabilitation facility.
    Comprehensive outpatient rehabilitation facility Services
  11. _______ The amount of expense a beneficiary must first incur before Medicare begins payment for covered services.
    deductible
  12. ______ 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
  13. __________ the difference between the Medicare approved amount for a service or supply and the actual charge.
    excess charge
  14. ___________ 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.
    Intermediaries
  15. __________ The Maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does nt accept assignment.
    Limiting Charge
  16. __________ Doctors or suppliers who may choose whether or not to accept assignment on each individual claim.
    Non-participating
  17. _______ 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
  18. ______ Provides for a pap smear to screen for cervical cancer once every 2 years.
    Pap Smear Screening
  19. ________ a program of outpatient mental health care
    Partial Hospitalization for Mental Health Treatment
  20. ___________ 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
  21. ________ 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
  22. _______ 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
  23. ______________ between January 1st and March 31st each year.
    General enrollment period
  24. ____________ if the individual or his/her spouse is employed and covered under a group health plan
    Special Enrollment period
  25. Under what hospital stay, does NOT include private duty nursing, a television or telephone in your room .(Part A)
    inpatient hospital stay
  26. What is the number of days can the inpatient hospital benefit start a new benenfit period and new deductible?
    60 days

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