Social Insurance Flashcards
How do you qualify for Medicare if you are not 65?
Must be entitled to SS disability income for 2 years
OR
has chronic kidney disease or impairment
Original Medicare consists of what two parts?
Part A and Part B
Do Ambulatory Surgical Services include surgeries that require in-patient hospital surgery?
No
What is the approved amount?
Part B
Amount that Medicare determines to be reasonable for services
What is assignment?
Physician accepts Medicare-approved amount as full payment for the services
Where is Durable Medical Equipment mostly used?
In home
What is an excess charge?
The difference between the Medicare-approved amount for the service and the actual charge.
Who are intermediaries?
Organizations that process inpatient/ outpatient claims on individuals
What is the Limiting Charge?
The max amount a physician can charge a Medicare beneficiary if the physician doesn’t accept assignment.
What are non-participating doctors allowed to do?
Can choose to accept assignment or not on each individual claim
Pap Smear screening how often?
Every 2 years
What is a Peer Review Group?
Groups of practicing doctors and others who are paid to review the care given to the Medicare patients.
Can insurers alter standardized benefits offered in each plan?
No but they can offer new, innovative benefits
Can plans be nonrenewable?
No, all plans are guaranteed renewable
What is the free look period for Medicare?
30 days
