Podcast
Questions and Answers
Anyone over age 65 who receives social security benefits is automatically enrolled in__________.
Anyone over age 65 who receives social security benefits is automatically enrolled in__________.
Medicare parts A and B
People over age 65 but who are not eligible for free part A coverage may enroll by__________.
People over age 65 but who are not eligible for free part A coverage may enroll by__________.
paying a premium
Retired federal employees who are enrolled in the civil service retirement system are eligible for Medicare benefits and their spouses.
Retired federal employees who are enrolled in the civil service retirement system are eligible for Medicare benefits and their spouses.
True (A)
_____ is also called hospital insurance.
_____ is also called hospital insurance.
Care in a skilled nursing facility is covered under __________.
Care in a skilled nursing facility is covered under __________.
______ was originally called Medicare+Choice.
______ was originally called Medicare+Choice.
_____ provides voluntary Medicare prescription drug plans.
_____ provides voluntary Medicare prescription drug plans.
Each Medicare enrollee receives a ____ issued by the Social Security Administration.
Each Medicare enrollee receives a ____ issued by the Social Security Administration.
CWF is the abbreviation for?
CWF is the abbreviation for?
Medicare part B does not provide benefits for __________.
Medicare part B does not provide benefits for __________.
_______ is performed for a patient who does not have symptoms, abnormal findings, or any past history of the disease.
_______ is performed for a patient who does not have symptoms, abnormal findings, or any past history of the disease.
ABN is the abbreviation for?
ABN is the abbreviation for?
The modifier GY is appended to procedure codes for non-covered Medicare services when __________.
The modifier GY is appended to procedure codes for non-covered Medicare services when __________.
Physicians who do not participate in the Medicare program do not accept the Medicare fee schedule charge amount as __________.
Physicians who do not participate in the Medicare program do not accept the Medicare fee schedule charge amount as __________.
___ of the fee on the Medicare NONPAR fee schedule equals the limiting charge.
___ of the fee on the Medicare NONPAR fee schedule equals the limiting charge.
Under the Medicare program, a nonparticipating physician may not bill more than 115% of __________.
Under the Medicare program, a nonparticipating physician may not bill more than 115% of __________.
The Medicare limiting charge is the highest fee that can be charged for a __________.
The Medicare limiting charge is the highest fee that can be charged for a __________.
Patients receive a _____ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed.
Patients receive a _____ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed.
Medicare advantage offers three types of plans including __________.
Medicare advantage offers three types of plans including __________.
Urgently needed care is defined in the Medicare program as?
Urgently needed care is defined in the Medicare program as?
A medigap plan offers __________.
A medigap plan offers __________.
All laboratory work paid for by __________.
All laboratory work paid for by __________.
CLIA is administered by?
CLIA is administered by?
Roster billing applies __________.
Roster billing applies __________.
Services supervised by the physician but provided by non-physician practitioners are billed under __________.
Services supervised by the physician but provided by non-physician practitioners are billed under __________.
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Study Notes
Medicare Overview
- Individuals over age 65 who receive Social Security benefits are automatically enrolled in Medicare Parts A and B.
- Those over age 65 not eligible for free Part A can enroll by paying a premium.
Medicare Benefits and Coverage
- Retired federal employees under the Civil Service Retirement System are eligible for Medicare benefits for themselves and spouses.
- Medicare Part A is referred to as hospital insurance and covers care in skilled nursing facilities.
- Medicare Part C, initially known as Medicare+Choice, encompasses various managed care plans.
- Medicare Part D offers voluntary prescription drug plans to enrollees.
Medicare Documentation and Notifications
- Each Medicare enrollee receives a Medicare card issued by the Social Security Administration.
- Common Working File (CWF) is the system used for managing Medicare claims.
- Advance Beneficiary Notification (ABN) informs beneficiaries about non-covered services.
Billing and Charges
- Medicare Part B does not cover cosmetic surgery procedures.
- Screening services are conducted for patients without symptoms or prior disease history.
- Modifier GY is used for procedure codes on non-covered Medicare services where an ABN is not mandatory.
- Non-participating physicians do not accept Medicare's fee schedule as full payment; they can bill up to 115% of the approved charges.
Non-participating Provider Limits
- The Medicare limiting charge defines the maximum fee that non-participating providers can charge for a procedure.
- Patients receive a Medicare Summary Notice (MSN) detailing services received, amounts charged, and billing amounts over a 30-day period.
Medicare Advantage and Medigap
- Medicare Advantage includes three plan types: Private Fee-for-Service Plans, Coordinated Care Plans (CCP), and Medicare Savings Accounts (MSA).
- Urgently needed care is categorized as unexpected illness or injury requiring immediate treatment.
- Medigap plans provide supplemental insurance, filling in gaps in Medicare coverage.
Laboratory Work and Regulations
- All laboratory services covered by Medicare adhere to CLIA regulations, which are managed by the Centers for Medicare & Medicaid Services (CMS).
- Roster billing pertains specifically to Part B claims.
Non-physician Practitioner Services
- Services provided by non-physician practitioners under physician supervision are billed using incident-to rules.
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