Medicare Chapter 8 Flashcards

Social Security Act

1965

18

<p>hospital insurance</p> Signup and view all the answers

<p>supplementary (outpatient) insurance</p> Signup and view all the answers

<p>outpatient prescription drug insurance</p> Signup and view all the answers

<p>parts A and B managed care</p> Signup and view all the answers

<p>Medicare</p> Signup and view all the answers

<p>centers for Medicare and Medicaid services (CMS)</p> Signup and view all the answers

<p>Age 65; Vested after 10 years of payroll contributions; End stage renal disease; ALS</p> Signup and view all the answers

<p>If eligible for Part A you are eligible for Part B; must pay monthly premium</p> Signup and view all the answers

<p>inpatient hospital care; SNF; home health care and hospice</p> Signup and view all the answers

<p>deductible, co-insurance fees</p> Signup and view all the answers

<p>admission to hospital until discharge from hospital or SNF for 60 days</p> Signup and view all the answers

<p>money paid after service has been done; old way</p> Signup and view all the answers

<p>money given before as an estimate for what client will need; new way</p> Signup and view all the answers

<p>per episode (admission)</p> Signup and view all the answers

<p>per day</p> Signup and view all the answers

<p>outpatient care, home health care, DME, prosthetics and orthotics</p> Signup and view all the answers

<p>annual deductible, co-insurance, monthly premium</p> Signup and view all the answers

<p>Medicare Physician Fee Schedules - fee for service</p> Signup and view all the answers

<p>Part C</p> Signup and view all the answers

<p>private insurance offered for purchase in addition to what client has</p> Signup and view all the answers

<p>raising eligibility age, means-testing</p> Signup and view all the answers

<p>length of time from day of admission to the hospital to 60 days post-hospital or SNF discharge. Determines deductible and co-insurance payments for Medicare program</p> Signup and view all the answers

<p>system of classifying patients for payment by clinical characteristics and anticipated resource utilization</p> Signup and view all the answers

<p>approval by a physician of a therapy plan of care for Medicare beneficiary</p> Signup and view all the answers

<p>retrospective method of payment whereby provider reports costs of provider care and is paid by insurer</p> Signup and view all the answers

<p>process used by insurance companies to analyze and decide whether or not to pay for a claim</p> Signup and view all the answers

<p>statutory guarantee to a set of benefits for eligible persons</p> Signup and view all the answers

<p>list of procedures with an associated payment amount for each service</p> Signup and view all the answers

<p>determination by a provider with physician status that a health care intervention is required. Prerequisite for reimbursement.</p> Signup and view all the answers

<p>nongovernment entity, typically an insurer, that receives, reviews and determines coverage for Medicare</p> Signup and view all the answers

<p>Part C; done by private insurers that is basically the same as Part A and B of Medicare</p> Signup and view all the answers

<p>agreement between provider and Medicare to accept fee schedule as payment in full services</p> Signup and view all the answers

<p>list of procedures and prices for outpatient therapy services for the Medicare program</p> Signup and view all the answers

<p>term for private supplemental insurance plans that provide benefits not provided by traditional Medicare</p> Signup and view all the answers

<p>cost containment that reduces practice expense portion of fee schedule amount for multiple procedure codes in the same visit</p> Signup and view all the answers

<p>quality reporting mechanism for Medicare</p> Signup and view all the answers

<p>form of health care payment whereby providers are paid a set fee prior to delivery of services.</p> Signup and view all the answers

<p>government-sponsored health insurance where people paying taxes are not eligible for benefits; benefits are paid to those who have a social need</p> Signup and view all the answers

<p>Medicare cost containment to limit growth in Medicare Part B by reducing standardized conversion factor</p> Signup and view all the answers

<p>annual financial limit placed on outpatient OT and PT; PT is combined with ST</p> Signup and view all the answers

<p>after payment of taxes into Medicare for 40 quarters (10 years) person is eligible for Part A benefits upon reaching retirement age, permanent disability or developing end-stage renal disease</p> Signup and view all the answers