Terms : Hide Images
| 4288641442 | Medicare Part A | reimburses institutional providers for inpatient, hospice, and some home health services | 0 | |
| 4288641443 | Medicare Part B | reimburses institutional providers for outpatient services and physicians for inpatient and office services. | 1 | |
| 4288641444 | Medicare Hospital Insurance (Medicare Part A) | pays for inpatient hospital critical care access; skilled nursing facility stays, hospice care, and some home health care. | 2 | |
| 4288641445 | Medicare Advantage (Medicare Part C) | formerly called Medicare+Choice, includes managed care and private fee-for-service plans that provide contracted care to Medicare patients. Medicare Advantage is an alternative to the original Medicare plan reimbursed under Medicare Part A. | 3 | |
| 4288641446 | Medicare Prescription Drug Plans (Medicare Part D) | add prescription drug coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans. | 4 | |
| 4288641447 | Special Enrollment Period (SEP) | a set time when they can sign up for Medicare Part B, if they did not enroll in Part B during the initial enrollment period | 5 | |
| 4288641448 | Specified low-income Medicare beneficiary (SLMB) | helps low-income individuals by requiring states to pay their Medicare Part B premiums | 6 | |
| 4288641449 | Hospice | is an autonomous, centrally administered program of coordinated inpatient and outpatient palliative (relief of symptoms) services for terminally ill patients and their families | 7 | |
| 4288641450 | Lifetime Reserve Days | (60 days) may be used only once during a patient's lifetime and are usually reserved for use during the patient's final, terminal hospital stay. | 8 | |
| 4288641451 | Private Fee-for-Service (PFFS) | plans are offered by private insurance companies and are available in some regions of the country. | 9 | |
| 4288641452 | Medicare Special Needs Plans | cover all Medicare Part A and Part B health care services for individuals who can benefit the most from special care for chronic illnesses, care management of multiple diseases, and focused care management. | 10 | |
| 4288641453 | Medicare Part D Coverage Gap | is the difference between the initial coverage limit and the catastrophic coverage threshold for the Medicare Part D prescription drug program. | 11 | |
| 4288641454 | Risk Adjustment Data Validation (RADV) | is the process of verifying that diagnosis codes submitted for payment by a Medicare Advantage organization are supported by patient record documentation for an enrollee. | 12 | |
| 4288641455 | Medicare Cost Plan | is a type of HMO available in certain areas of the country, which works in much the same way and has some of the same rules as a Medicare Advantage Plan. | 13 | |
| 4288641456 | Demonstration/Pilot Program | is a special project that tests improvements in Medicare coverage, payment, and quality of care. | 14 | |
| 4288641457 | Programs of All-Inclusive Care for the Elderly (PACE) | combine medical, social, and long-term care services for frail people who live and receive health care in the community. | 15 | |
| 4288641458 | Medication Therapy Management Programs | are available to Medicare beneficiaries who participate in a drug plan so they can learn how to manage medications through a free Medication Therapy Management (MTM) program. | 16 | |
| 4288641459 | Medicare SELECT | is a type of Medigap insurance that requires enrollees to use a network of providers (doctors and hospitals) in order to receive full benefits | 17 | |
| 4288641460 | Medicare Private Contract | is an agreement between the Medicare beneficiary and a physician or other practitioner who has "opted out" of Medicare for two years for all covered items and services furnished to Medicare beneficiaries. | 18 | |
| 4288641461 | Advance Beneficiary Notice of Noncoverage (ABN) | is a written document provided to a Medicare beneficiary by a supplier, physician, or provider prior to service being rendered to inform beneficiaries in the traditional fee-for- service Medicare program about possible noncovered charges when limitation of liability (LOL) applies. | 19 | |
| 4288641462 | Roster Billing | process was developed to enable Medicare beneficiaries to participate in mass pneumococcal polysaccharide vaccine (PPV) and influenza virus vaccination programs offered by public health clinics (PHCs) and other entities that bill Medicare payers. | 20 | |
| 4288641463 | Dual Eligibles | individuals entitled to Medicare and eligible for some type of Medicaid benefit (abbreviated as Medi-Medi). | 21 | |
| 4288641464 | Medicaid Eligibility Verification System (MEVS) | allows providers to electronically access the state's eligibility file using the following methods. | 22 | |
| 4288641465 | Adjusted Claim | has a payment correction, resulting in additional payment(s) to the provider. | 23 | |
| 4288641466 | Voided Claim | is one that Medicaid should not have originally paid and results in a deduction from the lump-sum payment made to the provider. | 24 | |
| 4288641467 | Surveillance and Utilization Review Subsystem (SURS) | safeguards against unnecessary or inappropriate use of Medicaid services or excess payments and assesses the quality of those services. | 25 | |
| 4288641468 | Mother/Baby Claim | is submitted for services provided to a baby under the mother's Medicaid identification number. | 26 | |
| 4288641469 | Medical Assistance Program | Federally mandated, state administrated program for individuals with incomes below the federal poverty level. | 27 | |
| 4288641470 | Accept Assignment | must be selected on the CMS-1500 claim, or reimbursement (depending on state policy) may be denied. | 28 | |
| 4288641471 | Federal Poverty Level | annual income guidelines established by the federal government | 29 |
