Medicare Key Terms and Concepts

Time during which medical benefits are available to insurance beneficiaries.

Temporary continuation of health coverage for 18 months after an appointment has ended.

Reassignment of gaps in coverage to eliminate the need for beneficiaries to file a separate claim with their medigap insurer.

<p>Total or nearly complete failure of the kidney.</p> Signup and view all the answers

<p>Electronic notification sent to the provider who accepts assignment.</p> Signup and view all the answers

<p>The private company that has a contract with Medicare to pay Part A and some Part B bills.</p> Signup and view all the answers

<p>The maximum amount nonparticipating providers can charge the Medicare patient on a non-assignment claim.</p> Signup and view all the answers

<p>A decision by Medicare, a carrier, or intermediary as to whether the service is reasonable or necessary.</p> Signup and view all the answers

<p>Improper payment for items or services when there was no legal entitlement to the payment.</p> Signup and view all the answers

<p>An option that offers extended benefits for a fee through private health insurance programs.</p> Signup and view all the answers

<p>Contractors awarded contract by CMS to adjudicate and pay Medicare claims.</p> Signup and view all the answers

<p>A letter sent to a provider by Medicare requesting additional information or documentation for the processing of a claim.</p> Signup and view all the answers

<p>Knowingly and intentionally executing a plan to scheme or defraud any healthcare benefits program.</p> Signup and view all the answers

<p>Hospital fees for the elderly, individuals with disabilities, and people with end-stage renal disease.</p> Signup and view all the answers

<p>Physician services, outpatient hospital care, durable medical equipment, and some services not covered by Part A.</p> Signup and view all the answers

<p>Offers extended benefits for a fee through private health insurance programs that contract with Medicare.</p> Signup and view all the answers

<p>Medicare prescription drug coverage program.</p> Signup and view all the answers

<p>Notice provided by Medicare contractors on assigned claims detailing how to explain the claims process.</p> Signup and view all the answers

<p>Any situation in which a payer is required by federal law to pay before Medicare pays.</p> Signup and view all the answers

<p>An easy-to-read document that clearly lists the health insurance claim information and details of services rendered.</p> Signup and view all the answers

<p>A privately purchased Medicare supplemental health insurance policy designed to provide additional coverage.</p> Signup and view all the answers

<p>Amount that applies to unassigned services performed by physicians and suppliers who choose not to participate in Medicare.</p> Signup and view all the answers

<p>To combat fraud, waste, and abuse and to improve the efficiency of Health and Human Services.</p> Signup and view all the answers

<p>Programs of all-inclusive care for the elderly.</p> Signup and view all the answers

<p>An organization that audits processed claims to identify and recover improper payments.</p> Signup and view all the answers

<p>Cleaning of the claim by a clearinghouse before submission to ensure data is entered correctly.</p> Signup and view all the answers

<p>Commitment to renewable energy resources and making health insurance more affordable for Americans, especially farmers and small businesses.</p> Signup and view all the answers

<ol> <li>Establishing policy for the reimbursement of providers, 2. Conducting research into healthcare management and treatment, 3. Assessing the quality of healthcare facilities and services.</li> </ol> Signup and view all the answers