Medicare Flashcards
Advanced Beneficiary Notice Of Non-Coverage (ABN)
a.k.a waiver of liability form
A notice a provider should give a Medicare (MDCR) beneficiary prior to receiving a service, if, based on Medicare coverage rules, the provider has reason to believe Medicare will not pay for the service
Benefit Period
The way the original Medicare program measures a beneficiary’s use of inpatient hospital and skilled nursing facility (SNF) services
It begins the day a beneficiary enters the hospital or SNF and ends when no further inpatient or SNF services have been rendered for 60 days in a row
Not tied to a calendar year
Can also be used to describe a length of time during which a benefit is paid
Medicare
Federal program providing insurance coverage for the elderly (age 65 and older), anyone who is permanently disabled or with end stage renal disease (ESRD)
The covered entity is called a Beneficiary
Medicare Part A
Federal health insurance program covering medically necessary inpatient hospitalization, care in skilled nursing facilities, home health and hospice care
Medicare Part B
Federal health insurance that helps pay for doctor services, outpatient hospital care, and some other medical services
Medicare Part C
a.k.a. replacement, advantage, Managed HMO plans
When Part C is elected, one is paying a private insurance company (i.e., Blue Cross or Humana) to handle their insurance, instead of Medicare
Medicare Part D
Outpatient prescription coverage, including Self-Administered Drugs (SADs) provided in an outpatient setting
Medicare Part F
a.k.a. Medigap or Medicare Supplemental
Additional coverage a beneficiary can purchase to help offset costs from traditional Part A and B coverage
Medicare Summary Notice (MSN)
Medicare Summary Notice (MSN)A notice of beneficiaries using traditional Medicare insurance will receive every 3 months (quarterly) showing all Part A and Part B covered services
Medicare Secondary Payor Questionnaire (MSPQ)
A questionnaire designed to assist in the practice of determining which insurance carrier should be the primary payer of the account in order for the bill to be sent to the correct insurance payer and avoid delays
State Health Insurance Assistance Program (SHIP)
Provides Medicare beneficiaries with information, counseling, and enrollment assistance at no cost to the beneficiary
