Healthcare Delivery

Question 1

Subrogration

Answer 1

only 1 insurance company pays for a bill

Question 2

Guardian ad litem

Answer 2

a designated guardian has the right to make decisions for the patient

Question 3

Pre-emption

Answer 3

fed controls state and state controls the city

Question 4

DEA

Answer 4

purpose to enforce the controlled substance laws

Question 5

Is hippa a federal or state law

Answer 5

federal

Question 6

What is a premium?

Answer 6

what you pay per month for an insurance

Question 7

What is a co-insurance?

Answer 7

the second insurance that helps to cover service if first service isn’t enough

Question 8

Which of the 4 characteristics of insurance is a fixed amount?

Answer 8

co-pay

Question 9

Who pays for medicare and who is it for?

Answer 9

75% is paid through federal taxes while 25% is paid through the patients. Medicare is for the elderly and extremely sick.

Question 10

What is medicare D for?

Answer 10

deals with drugs

Question 11

What is medicare c4 and what is another name for it?

Answer 11

also called medicare advantage. its very restrictive, leading to smaller fees but more limited choices.

Question 12

What does medicare A deal with?

Answer 12

deals with hospitals and long term care

Question 13

What does medicare B deal with?

Answer 13

deals with doctor services, emergency rooms, and ambulatory clinics

Question 14

What is fica?

Answer 14

tax taken out of a paycheck(7.5%) for social security

Question 15

How’s medicare A paid for and who’s exempt from paying?

Answer 15

it’s paid for by taking 1.5% out of everyone’s paycheck. people making over $125,000 are exempt from paying

Question 16

How is medicare B paid for?

Answer 16

Congress decides how much money comes out of federal tax to go towards the payments

Question 17

What does the social security administration do?

Answer 17

Decides whether you’re eligible or not

Question 18

What are the criteria to be eligible for medicare A

Answer 18

1. you or your spouse worked 40 quarters or 10 years (1 quarter = 12 weeks)
   2.must be a U.S. citizen, permanent resident or green card holder
2. must be at least 65 years old, have end stage renal disease or have been disabled for 2 years.
   all three have to be met unless patient has ESRD or disability for 2 years

Question 19

What are the criteria to be eligible for medicare B

Answer 19

must have part A plus you must pay a premium

Question 20

What does medicare pay for?

Answer 20

medicare only pays if medically necessary and reasonable

Question 21

What is CMS and what does stand for?

Answer 21

the Center for Medicare and Medicaid Services and is responsible for the administration of several key healthcare programs

Question 22

What can medicare not pay for?

Answer 22

it won’t pay for never events

Question 23

How is each illness covered through medicare A and B?

Answer 23

they only give a certain amount of benefits defined per illness, do not continue to cover further for specific illness even if patient still isn’t well

Question 24

When does medicare offer $0 co-pay?

Answer 24

only the first time you ever use them. never again.

Question 25

When is deductible not counted when dealing with medicare?

Answer 25

medicare B pays for treatment existing conditions regardless of the deductible

Question 26

How does medicare B work?

Answer 26

1. pya for what is left of the deductible 2. take final bill, if there is any money still due. subtract the deductible amount that was just paid in number 1. then take the balance and multiple it by 0.2 3. final amount due is number 1 + 2

Question 27

Medicare B patients pays how much of their services?

Answer 27

20% of all services

Question 28

What is the time frame for medicare B benefits?

Answer 28

starts January 1 12:00am and ends December 31 11:59:59

Question 29

What is the time frame for medicare A benefits?

Answer 29

starts when admitted in the hospital as an inpatient. ends when out of the hospital for 60 consecutive days

Question 30

How does medicare payment for hospital visits work?

Answer 30

they only pay per day. the first day doesn't start until the first midnight that the patient stays

Question 31

What does DRG stand for and what does it do?

Answer 31

Diagnosis Related Group. groups decided by medicare that categorize different conditions and decide how many days in the hospital they will pay for per condition and they always pay the same amount, even if the patient stays longer or shorter than expected.

Question 32

How does medicare feel about custodial care?

Answer 32

they dont pay for it

Question 33

What is medigap and how does it work?

Answer 33

it pays deductible, co-pay and co-insurance in full and

Question 34

what is another name for Mass. health?

Answer 34

Medicaid

Question 35

when is medicaid used?

Answer 35

it is the last resort option

Question 36

how is medicaid paid for?

Answer 36

depending on how wealthy each state is, state may pay 25%(poor)-50%(wealthy) and fed pays 50%(wealthy)-75%(poor)

Question 37

what is used to determine if patient fits with medicaid?

Answer 37

its the Mandatory Categorically Needy

Question 38

what is TANF?

Answer 38

one of the categories of MCN. Temporary Aid to Needy Families

Question 38

What does AFDC stand for and who does it cover?

Answer 38

Aid to Families with Dependent Children. To receive, must not exceed 30% above federal poverty guideline and child must only be living with one parent or relative

Question 39

What does SSI stand for and who does it cover?

Answer 39

Suplemental Security Income and covers those who are extremely poor and disabled for two years

Question 40

What're all the plans under MCN

Answer 40

TANF, AFDC, SSI, Pregnant woman with children 6 or under, QMB, children under 19 and foster families ACA, and QDWI

Question 41

QMB

Answer 41

Qualified Medicare Beneficiaries and covers those who qualify for medicare but can't afford premium

Question 42

QDWI

Answer 42

Qualified Disabled and Working Individuals

Question 44

ACA

Answer 44

Affordable Care Act aka Obamacare and covers working adults without children living in a state that accepts this plan

Question 45

if the patients illness/injury is not improving, what does medicare do?

Answer 45

they stop paying for care

Question 46

spend down period

Answer 46

have to liquidate all your money before the fed steps in to pay for your medical bills

Question 47

look back period

Answer 47

5 years + a day

Question 48

penalty period

Answer 48

coincides with the look back period. they "look back" at all the transactions you've made within the 5 years and anything that the fed seems unfit, they hold out from paying medical bills until you've paid that amount

Question 49

what does VA stand for and what is it?

Answer 49

Veterans Administration and its healthcare for veterans

Question 50

who is eligible for VA?

Answer 50

people who have been fighting for the military during the time of war for 24 months, had honorable discharge during war or had been injured during war

Question 51

who do groups 1-4 in VA entail?

Answer 51

represents the intensity of injury.

Question 52

who does group 5 in VA entail?

Answer 52

veterans who need medical care due to non-war related injuries. they are also very poor

Question 53

who does group 6 in VA entail?

Answer 53

veterans who're exposed to radiation during war

Question 54

who does group 7 in VA entail?

Answer 54

veterans who need medical care due to non-war related injuries but are not that poor

Question 55

who does group 8 in VA entail?

Answer 55

veterans who need medical care sue to non-war related injuries but are wealthy