AAHAM CRCS STACK 5
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| What does MC part A cover and what is the cost? | show 🗑
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| What is Medicare also known as and what act is it part of? | show 🗑
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| show | 65+
People with permanent disabilities
People with ESRD (End stage renal disease)
People with Lou Gehrig's disease
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| show | Lifetime Reserve:
MC Part A gives a LTR of 60 days of inpatient hospital svc they can opt to use after using 90 days of in-pt in a benefit pd.
The cost is 50% of the MC part A ded per day and it does not renew.
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| What does Medicare Part B cover? | show 🗑
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| show | MC Advantage/replacement plan.
Managed care coverage provided by private ins co approved by MC.
Private ins co is paid a fixed amt / mo and must follow MC rules.
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| show | HMO (Health Maintenance Org) -must get care form in-net providers.
PPO (Preferred Provider org) -can see any provider that accepts MC, no referral needed for specialist.
Private fee for svc plans -can go to any provider that accepts plan terms.
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| Types of Medicare Advantage Plans: 2 of 2) Special Needs Plan Medical Savings Account | show 🗑
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| show | MC Prescription Drug Plan
Subject to annual deductible which varies, but the maximum allowed for 2023 is $505
Each drug is put into a tier, each tier has a different copay.
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| show | MC Admin Contractor:
Private firms that process MC claims. primary operational provider contact. Enroll providers in MC, provide edu on billing requirements, ans provider & pt inquiries.
Currently 12 part a/b & 4 DME macs, process based on location.
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| show | Prov accepts assignment yearly, stating that for MC pts:
-will be paid by MC
-get only MC allowed amt, no ABN allowed
-charge pt only $ if non-cov svcs and co-ins/ded
IF THEY DON'T SIGN:
-Can charge up to 115% of approved amt
-can ask pt to pay full
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| What does HICN / MBI stand for and what does it look like? | show 🗑
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| Medigap | show 🗑
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| show | Title XIX (19)
Low income adults, children, pregnant women, elderly adults and people with disabilities.
Funded by Fed and state gov't.
State have authority to: establish eligibility standards, determine what is covered and set payment rates
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| Tricare: who is covers and rules: | show 🗑
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| show | Non-availability Stmt
before non-emer IP svcs can be provided to a Tricare Extra/standard Eligible bene by a non Mil Trtmt Fac (MTF)
NAS issued by MTF Commander, valid 30 days and thru 15 days after discharge.
Must go to MTF w/i a 40 mile catchment
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| What does CHIP stand for and who does it cover? | show 🗑
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| show | State sets rules for eligibility standards, benefit coverage, pmt level, operating procedures.
Must cover: in/out pt hospital care, Dr. surgical and medical services, well baby/child visits.
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| What does it mean to be self insured? | show 🗑
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| What is commercial insurance? | show 🗑
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| What is liability insurance? | show 🗑
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