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CertReview5 3/24
Quiz 5
| Question | Answer |
|---|---|
| medical necessity | The medical documentation needed for a particular medical intervention |
| Medicare Administrative Contractor (MAC) | Processes Medicare Parts A and B claims from hospitals, physicians, and other providers |
| Medicare Advantage (MA) | Combined package of benefits under Medicare Part A and B that may offer extra coverage for services such as vision, hearing, dental, health and wellness, or prescription drug coverage |
| Medicare | Federally funded health insurance provided to people age 65 or older, people younger than 5 who have certain disabilities, and people of all ages with end-stage kidney disease. Funded and administered at the national level |
| Medicare Part A | Provides hospitalization insurance to eligible individuals |
| Medicare Part B | Voluntary supplemental medical insurance to help pay for physicians' and other medical services, and medical-surgical supplies not covered by medicare part A |
| Medicare Part D | A plan run by private insurance companies and other vendors approved by Medicare |
| Medicare specialty plan | Plan that provides focused, specialized health care for specific group of people, such as those who have both Medicare and Medicaid, live in a long-term care facility, or have chronic medical conditions |
| Medicare Summary Notice (MSN) | Document that outlines the amounts billed by the provider and what that patient must pay the provider |
| Medigap | A private health insurance that pays for most of the charges not covered by parts A and B |
| modifier | Additional information about types of services, and part of valid CPT or HCPCS codes |
| morbidity | The number of cases of disease in a specific population |
| mortality | The incidence of death in a specific population |
| MS-DRG grouper | Software that helps coders assign the appropriate Medicare severity diagnosis-related group based on the level of services provided, severity or illness or injury, and other factors |
| National Provider Identifier (NPI) | Unique 10-digit code for providers required by HIPPA |
| Network model | HMO that contracts with two or more independent practices |
| Notice of Exclusion from Medicare Benefits | Notification by the physician to a patient that a service will not be paid |
| ordering provider | A physician or other licensed health care professional (e.g., physician assistant, nurse practitioner) who prescribes services for a patient |
| out-of-network | Not contracted with the health plan |
| out-of-pocket maximum | A predetermined amount after which the insurance company will pay 100% of the cost of medical services |
Created by:
sbogle
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