Health Insurance Chapter 14, 15
| Question | Answer |
|---|---|
| This helps individuals whose assets are not low enough to qualify them for medicaid by requiring states to pay their medicare part A and B premiums, deductibles, and coinsurance amounts | qualified medicare beneficiary program (QMBP) |
What simplified process was developed to enable Medicare beneficiaries to participate in mass?
What simplified process was developed to enable Medicare beneficiaries to participate in mass pneumococcal pneumonia virus (PPV) and influenza virus vaccination programs offered by public health clinics? roster billing.
Which program pays for inpatient hospital critical care?
Medicare Part A pays for inpatient care in hospitals, skilled nursing facilities, and critical access hospitals.
Which allows providers to electronically access the states eligibility file to verify?
The Medicaid eligibility verification system allows providers to electronically access the state’s eligibility file.
Which refers to the contractual right of a third party?
Which refers to the contractual right of a third-party payer to recover health care expenses from a liable party? Subrogstion. Third-party recovery standards for investigation of liability coverage and the process for filing a lien in a potential liability case vary on a federal and state basis.
Which program helps individuals that have lost their disability benefits?
The Qualified Disabled Working Individual (QDWI) program is a state-administered program that pays Medicare Part A (hospital insurance) premiums for disabled people who have gone back to work. There are certain basic requirements you must meet to be eligible. You must: be under the age of 65.
Which program includes managed care and private fee-for-service?
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.
Which programs pays for inpatient hospital critical care access skilled nursing facility stays hospice care and some home health care?
Medicare Part A (Hospital Insurance)—Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B (Medical Insurance)—Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
What is the DRG payment system?
Diagnosis-related group reimbursement (DRG) is a reimbursement system for inpatient charges from facilities. This system assigns payment levels to each DRG based on the average cost of treating all TRICARE beneficiaries in a given DRG.
What is PPS healthcare?
A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services).
Which established a state administered medical assistance program for individuals with incomes below the federal poverty level quizlet?
in 1965 congress passed title 19 of t he social security act establishing a federally mandated state administered medical assistance program for individuals with incomes below the federal poverty level.
Under which program does the federal government send Medicaid funding to states?
The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP).
What is the largest single medical benefits program in the United States?
The Medicare program is the nation’s single largest health program with over 60 million beneficiaries. The program has undergone rapid change as millions more have enrolled in private managed care plans, including those eligible for Medicaid benefits (dual eligibles).
What is a subrogation clause quizlet?
Subrogation Clause. Prevents a property owner from collecting on a claim from both the title company and the seller. allows the title company to reduce the amount of compensation that they pay by the amount of any damages paid by the seller to the buyer. Title Insurance Policy.
What is the birthday rule?
Birthday Rule: This is a method used to determine when a plan is primary or secondary for a dependent child when covered by both parents’ benefit plan. The parent whose birthday (month and day only) falls first in a calendar year is the parent with the primary coverage for the dependent.
What is a subrogation clause in real estate?
Subrogation clauses are used in the real estate industry and insurance industry and allows insurance companies to follow a lawful claim against a third party that caused damages to the insured. They fall under the common law legal system if a dispute over indemnity or enforceability occurs.
Which program helps individuals who receive Social Security and Medicare?
The Qualified Disabled Working Individual (QDWI) program is available to people who had Social Security and Medicare benefits because of a disability, but lost them because they returned to work and their earnings exceeded the allowable limit. QDWI pays for the Medicare Part A premium, but it doesn’t pay for Part B.
What does SLMB stand for?
Specified Low-Income Medicare Beneficiary
Specified Low-Income Medicare Beneficiary (SLMB): Pays only the monthly Medicare Part B premiums.
What does QMB stand for?
Qualified Medicare Beneficiary
Qualified Medicare Beneficiary (QMB) Program.
What is Medicare PFFS plan?
A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan, offered by a State licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services (CMS) to provide beneficiaries with all their Medicare benefits, plus any additional benefits the company decides
What part of Medicare includes managed care and private fee-for-service plans that provide contracted care to Medicare patients?
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).
