Medicare/ Medi-cal

Question 0

Partnership

Answer 0

Managed care

Administered by blue cross

Question 1

CSMP

Answer 1

Country medical services program

Began in 2005

Question 2

Share of cost

SOC

Answer 2

Portion patient must pay before medi-cal will pay

Question 3

Part A

Answer 3

Hospitals and facilities

Question 4

Part B

Answer 4

Physicians and outpatient services

Question 5

Part C

Answer 5

Managed care

Question 6

Part D

Answer 6

Prescription drugs

Question 7

Eligibility for Medicare

Answer 7

65+, paid ten years medicare taxes, or qualified disabled and those with end stage renal disease(ESRD)

Question 8

Medi-medi

Answer 8

Medicare and medi-cal

Question 9

Medigap

Answer 9

Insurance bought by patient to cover the balance after Medicare pays. Automatically crosses over from Medicare. Patient pays the premium.

Question 10

When is Medicare second payer

Answer 10

Medicare always pays first except

1) condition related to auto accident or liability insurance
2) patient is working and covered by plan or spouse is covered
3) work related condition.

Question 11

ABN

Answer 11

Advanced beneficiary notice

Not covered by medical, Not medically necessary

Question 12

Who is MAC of ca

Answer 12

Palmetto

Question 13

Medicare part B deductible

Answer 13

20%

Question 14

TAR

Answer 14

Treatment authorization request

Question 15

Where patient goes to apply for benefits

Answer 15

County social services

Question 16

Payer of last resort

Answer 16

Medi-cal

Question 17

RA

Answer 17

Remittance advice

Question 18

EOMB

Answer 18

Explanation of medical benefits

Question 19

MAC

Answer 19

Medicare administrator contractor

Question 20

Medi-cal is always the last payer when

Answer 20

There is more than one insurance involved

Question 21

Crossover claim

Answer 21

Also called a claims transfer
Medicare carriers file a medicap claim electronically for participating providers eliminating the need for the provider file an additional claim

Question 22

Medicare remittance advice

RA

Answer 22

Also called an EOMB
Sent to providers office
Describes payment or denial of a processed claim

Question 23

MSN

Answer 23

Medical summary notice

Similar to RA or EOMB but sent to beneficiary

Question 24

Point of service device

Answer 24

Used to manually enter or swipe patients card

Info will display or provide a printed reciept

Question 25

RTD

Resubmission turnaround document

Answer 25

Sent to providers providers when submitted claim form has Questionable or missing info
Always a deadline listed when form must be returned

Question 26

CIF

Answer 26

Claims inquiry form

Used for tracing a claim, resubmitting a claim following denial and general inquiries as to status of your claim