Medicare Flashcards
who is in charge of medicare?
centers for medicare and medicaid services (CMS) through fed govt
What are the different parts of Medicare?
med A inpatient
med B outpatient
med C medicare advantage (3rd party managed care)
med D prescription drugs
does medicare guarantee enrollment?
yes, it is an entitlement program funded by taxpayers.
anyone 65 and up is eligible fully vested is 10years/40 quarters
or permanently disabled/end stage renal disease
what are the premiums for med a if fully vested?
$0
What does med a cover and how much?
hospital inpatient $1260 deductible for each “benefit period” no co-ins for 1st 60 days at day 61 $315 co-ins/day
SNF 100 days max. 20 days no co-ins. at day 21 $157.50 co-ins/day
home health (hospice) no deductible
t/f: if you have med a, you must have med b
false, med b is an optional program available if fully vested in med a
what is the 60% rule for inpatient rehab facilities?
in order for inpatient rehab facilities to receive reimbursement through med a, 60% of their residents must have a qualifying diagnosis and pat need 3 hours of treatment/day
what is the cap?
it is the med b limit on pt/ot/sp services $1940 with possible extension to $3700
What treatment info is required by med b for therapy?
poc that includes diagnosis, long term goals, type/amt/frequency of treatment
and certification of therapist/clinic
What supervision levels does medicare require for ptas?
general supervision, unless private clinic=direct
What is assignment?
provider accepting whatever medicare pays as full payment
what organization certifies hospitals?
JACHO
what organization certifies providers
medicare
t/f: medicare is the largest single payer of health care services
true
