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MEDICARE
LESSON 2 MEDICARE AND MADICAID
| Question | Answer | |
|---|---|---|
| EXPLAIN THE DIFFERENT PARTS OF MEDICARE AND WHAT THEY COVER. | Medicare Part A: hospital insurance. Part B: medical insurance that covers physician services. Part C: expanded benefits for HMO's and PPO's, Part D: Rx. drugs | |
| WHO IS ELIGIBLE FOR MEDICARE BENEFITS? | Individuals 65 and older, people with disabilities. People who became disable before age 18. and those with end stage renal disease. | |
| WHAT DOES "ACCEPTING ASSIGNMENT" MEAN WITH MEDICARE? | A provider who has agreed to accept the allowed charge of a rendered service as payment in full. | |
| WHAT DOES IT MEAN WHEN THE PHYSICIAN IS A "NONPARTICIPATING PHYSICIAN?" | A non participating physician is one that chooses not to participate in a Medicare Plan. | |
| WHEN A MEDICARE PART A BENEFICIARY IS HOSPITALIZED, WHAT WILL THEY HAVE TO PAY? | Deductible for days 1-60. co-pay for days 61-90 | |
| WHAT WAS MEDICARE PART A DEDUCTIBLE I N 2007? | Medicare Part A deductible for all Medicare beneficiaries is $992 days 1-60 | |
| TO QUALIFY FOR MEDICARE, A DISABLED ADULT MUST HAVE BEEN RECEIVING SOCIAL SECURITY DISABILITY (SSD) BENEFITS FOR HOW LONG? | For two years. | |
| HOW LONG IS EACH BENEFIT PERIOD? | A benefit period begins. when the patient goes to a hospital or a skilled nursing facility. The benefit period ends when you have not received any inpatient hospital care for 60 days in a row. | |
| HOW IS THE MONTHLY PREMIUM FOR MEDICARE PART B DETERMINED? | Medicare uses the modified adjusted gross income reported on your IRS tax return from two years ago (the most recent tax return info.) | |
| AFTER A MEDICARE PART B BENEFICIARY PAYS THE DEDUCTIBLE, WHAT AMOUNT WILL MEDICARE PAY? | Medicare will pay 80% and the patient will pay 20% | |
| WHAT IS THE GOAL OF MEDICAID MANAGED CARE? | To reduce Medicaid Program costs and better manage utilization of health services. improvement in health plan performance, healthcare quality, and outcomes. | |
| WHO PAYS FOR MEDICAID? | The federal and state government. | |
| WHICH ORGANIZATION IS RESPONSIBLE FOR DETERMINING THE TYPE, AMOUNT, AND SCOPE OF SERVICES COVERED BY MEDICAID? | Each state government. | |
| WHAT ARE THE THREE GROUPS WHO ARE ELIGIBLE FOR MEDICAID? | The categorically needy, the medically needy; and special groups. (pregnant women) | |
| WHO DETERMINES THE ELIGIBILITY FOR TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)? | The county | |
| THE EPSDT PROGRAM INCLUDES COVERAGE FOR CHILDREN YOUNGER THAN? ---- | Children younger than age 21 | |
| HOW OFTEN SHOULD THE ELIGIBILITY BE CHECKED FOR A MEDICAID BENEFICIARY? | Patient's eligibility should be checked each time they make an appointment and before they see the physician. (Every visit) | |
| WHAT IS THE TIME LIMIT A MEDICAID CLAIM MUST BE FILED BY? | within 95 days from discharge from hospital or date of service. | |
| WHAT IS THE DEADLINE TO APPEAL A DENIED CLAIM? | 180 days | |
| WHEN FILING A CLAIM FOR A NEWBORN BABY BOY, FOR MOTHER SALLY SMITH, HOW SHOULD THE NAME BE LISTED ON THE CLAIM? | The name field of the claim form should state Boy Sally Smith. |
Created by:
Lizbeth Romo
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