Medicare & Medicaid Rules Flashcards
Medicare Part A
Is part of title 18, and cover inpatient services- Hospital stays, Skilled care, 80% of HHC.
People age 65+ automatically get _____
Medicare Part A at no premium
First ____ are co-pay free.
Days ___ to ___ have a ____ percent copay
20 days, 21-100, 20%
____ Days to be eligible for another 100 days.
60 days
Medicare Part B
Outpatient Services. Has monthly premium, covers HHC at 100%
Medicare Part B doesn’t cover ______ Care
Custodial
Medicare Part D
Prescription drugs
Medicaid Title 19
Income limit $1,860, Asset limit of $2,000, 5 Year look back period.
Bed Certification
Beds are either medicaid or medicare certified or dully certified for either medicaid or medicare.
How many times a year can you change your bed certification?
2 times a year.
When are cost reports due to medicaid?
within 90 days of the end of the facility fiscal or calendar year.
What is the cost reports used for by medicaid?
Used to determine your medicaid rate.
PASSR
Pre-admission and Pre-Screening
Why is a PASSR done?
To evaluate new admissions. it checks mental illness/ mental retardation, and he need for 24 hour care. This qualifies patients for LTC paid for by medicaid
CUSTODIAL CARE OR INTERMEDIATE
care involves observing an individual and monitoring nutritional intake and hydration, assist with activities of daily living and administer medications
SKILLED NURSING CARE
involves skilled nursing such as tube feeding, wound care, IV’s and other services required of a licensed nurse.
Medicare Part A pays for
Inpatient care in a hospital or nursing home.
Individuals are entitled to Part A at age 65 and do not pay a premium
Medicare Part B pays for
Individuals must elect to purchase Part B, pay a monthly premium and also co-pays.
Medicare Pat D pays for
is the prescription drug plan that individuals must enroll in and pay premiums and copays.
Medicaid program is based off what?
financial need.
Income limit $1860
Asset limit $2000
5 year look back period
Medicaid covers…
non skilled care or custodial care only.
Medicaid eligibility income must be under ____, assets limit of_____, over a ___ year look back period.
Income limit $1860
Asset limit $2000
5 year look back period
