Timelines and Deadlines Flashcards
The Important Message from Medicare must be issued _
within 2 days of admission
and again
within 2 days of discharge
To qualify for SNF coverage, Medicare requires a person to have been a hospital inpatient for _
at least 3 consecutive days (not including the day of discharge).
For recurring outpatient accounts, an MSPQ can be completed _ if the beneficiary is receiving identical services and treatments as the month before.
once every 90 days
Patients pay a deductible for Part A coverage once per spell of an illness (also known as the benefit period), which begins when a beneficiary enters the hospital and ends _.
60 days after discharge from the hospital or from a SNF
Part A benefits include a “lifetime reserve” (LTR) of _ of inpatient hospital services that a beneficiary can opt to use after having used _ of inpatient hospital services in a benefit period.
60 days
90 days
A TRICARE sponsor is eligible for TRICARE after having been on active duty for _ . Other members are eligible after the sponsor has been on active duty for _ .
1 day
30 days
The NAS is valid for _ for the specific reason requested and obtained. The NAS remains valid from the date of admission until _ for any follow-up treatment related to the admission stay.
30 days after the date of issuance
15 days after discharge
When another payer is responsible, but the claim is not expected to be paid promptly (promtly is usually to considered to be _ ), Medicare will make a conditional payment to prevent the beneficiary from having to pay out of pocket.
within 120 days from receipt of the claim
CMS allows a hospital to file subsequent inpatient DRG adjustments _ for Medicare beneficiaries.
up to 60 days from the date of the remittance advice
Under Locum Tenens and Reciprocal Agreements, a substitute physician can be paid for services provided to a Medicare patient as long as the substitute physician does not provide services to the patient for more than _ .
60 days
There is a Medicare regulation that requires all diagnostic and clinically related non-diagnostic outpatient services provided within _ of an inpatient admission to be combined to the inpatient claim when they are provided by an entity wholly owned or operated by the inpatient hospital (or by another entity under arrangements with the admitting hospital).
3 days
For inpatient psychiatric hospitals, inpatient rehabilitation facilities, long term care facilities, children’s hospitals, and cancer hospitals, the Medicare regulation requires all diagnostic and clinically related non-diagnostic outpatient services provided within _ of an inpatient admission to be combined to the inpatient claim when they are provided by an entity wholly owned or operated by the inpatient hospital (or by another entity under arrangements with the admitting hospital).
1 day
Medicare allows _ to correct incomplete or invalid claims
45 days
The process to terminate a patient relationship should include providing in writing, with a return receipt requested, a _ day notice to terminate care.
30 day
TJC will conduct an audit of a hospital every _ and of a laboratory every _ . The organization can audit a healthcare facility without advance notice, as early as _ after its initial audit.
39 months
2 years
9-30 months
The coordination of benefits period for MSP for ESRD patients is _
30 months
Medicare coverage for ESRD will end _ after the month the individual no longer requires maintenance dialysis, _ after a successful kidney transplant, or if the patient becomes deceased.
12 months
36 months
An Initial Enrollment Questionnaire (IEQ) is mailed _ before patients become entitled to Medicare
about 3 months
Enrollment in Part B is voluntary. Beneficiaries may sign up for Part B coverage anytime within the _ period that begins _ before turning 65
7-month
3 months
All Medicare providers must submit claims for services within _ from the date of service.
12 months
Under Chapter 11 bankruptcy, a business is granted _ to draft an initial plan; after that, anyone can submit a plan.
3 months
In the case of a Chapter 7 bankruptcy that is deemed to have no assets, the discharge order is usually entered within _ , unless an objection to discharge is filed.
6 months
A new patient is one who has not received any professional services from that physician or any physician in a group practice within _ .
the past 3 years
Per CMS, an ABN must be retained for _ from discharge or the completion of the care, provided that there are no other applicable requirements which fall under state-specific law.
5 years
All MSP information obtained on patients must be retained by the provider for _ .
10 years
Under the Medicare Participating Physician Program, doctors sign a “participation agreement” binding them to accept assignment for all services provided to Medicare patients for _ .
the following year
Medicare part A and B require a blood deductible that is currently _ (unless the patient or someone else donates to replace it)
the cost of 3 pints per year
Under Chapter 13 bankruptcy, debtors are permitted to repay creditors, in full or in part, in installments over _ , during which time creditors are prohibited from starting or continuing collection efforts. A plan providing for payments over a longer period must be “for cause” and be approved by the court. In no case may a plan provide for payments over a period longer than _ .
a 3-year period
5 years
As a preventative service, how often does Medicare Part B cover an initial wellness visit?
once per lifetime
As a preventative service, how often does Medicare Part B cover an annual wellness visit?
once per year
As a preventative service, how often does Medicare Part B cover bone mass measurements?
variable but generally once every 2 years
As a preventative service, how often does Medicare Part B cover PSA screening?
once per year for patients over the age of 50
As a preventative service, how often does Medicare Part B cover influenza vaccinations?
once per year
As a preventative service, how often does Medicare Part B cover mammograms?
once if between 35 and 40 years of age
once per year if 40 or older
As a preventative service, how often does Medicare Part B cover colorectal screening?
FOBT once per year
variable for other tests
As a preventative service, how often does Medicare Part B cover diabetes screening?
Part B covers glucose monitors, test strips, lancets, and diabetes self-management training
For screening, Part B covers 2 screening tests per year for beneficiaries diagnosed with pre-diabetes or 1 screening per year if previously tested but not diagnosed with pre-diabetes, or if never tested.
As a preventative service, how often does Medicare Part B cover lung cancer screening?
Once per year for beneficiaries between ages 55-77
