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34 Cards in this Set
- Front
- Back
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PACE |
Program of All-Inclusive Care for the Elderly |
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What is the goal of PACE? |
To help people remain independent and live in their community as long as possible |
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What is the largest single medical benefits program in the US? |
Medicare |
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What regulates ROI (release of information)? |
The Privacy Act of 1974
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What is a demonstration/pilot project? |
It is a special project that tests improvements in Medicare coverage, payment and quality of care. |
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What do Medicare savings programs do? |
Help people with low income and asset levels pay for health care coverage |
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Who is responsible for the operation of Medicare? |
CMS |
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What was the benefit period formerly known as? |
The spell of illness or spell of sickness |
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Why was Medigap designed? |
To supplement Medicare benefits by paying for services that Medicare does not cover. |
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When does the benefit period end and begin? |
The first day of hospitalization and ends when the patient has been out of the hospital for sixty days. |
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Medicare Part A |
Covers institutional providers for inpatient services |
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Medicare Part B |
Physician services, outpatient hospital and other services not covered by Medicare (also home health services if the patient is not covered by Part A) |
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Medicare Part C |
Medicare Advantage Plan: If you join a Medicare Advantage Plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage |
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Medicare Part D |
Prescription Drugs |
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What may Medicare Advantage Plans offer? |
Extra coverage for vision, hearing, dental, and/or health and wellness programs and most include Medicare prescription drugs (Part D) |
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What does General Medicare eligibility require of an individual or their spouse? |
Be at least 65 years old, be a citizen or permanent resident of the US, and have worked at least 10 years in Medicare covered employment |
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How can a person qualify for Medicare services if they are younger than 65? |
They must be disabled or diagnosed with ERSD |
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What is the annual deductible for Medicare? |
$135 |
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What are the special incentives mandated by Congress to increase the number of health care providers signing participating provider agreements with Medicare? |
Direct payment of all claims, publication of PAR directory to all Medicare patients, and 5% higher fee schedule |
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What is the general enrollment period? |
January 1st through March 31st each year |
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When is hospice care provided? |
When the provider is unable to do anything to stop the progression of disease and the patient is only treated to relive pain |
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What are the three limits for hospice care? |
Two period of 90 days each, one 30 day period, and a final "lifetime" extension of unlimited duration |
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RVU |
Relative Value Unit |
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What is an RVU? |
Where resources such as physician work, practice expense and malpractice expenses are taken into consideration when calculating physician fee schedules |
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How can patients join the Medicare Prescription Plan? |
By paying a monthly premium and annual dedcutible |
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Medicare Cost Plan |
Individual receives health care from a non network provider, original Medicare plan covers services |
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Medicare reimburses providers based on what? |
Physician fee schedules and RBRVS |
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Medicare Savings Account |
Money managed by Medicare approved insurance company |
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Initial enrollment period |
Provides opportunity to enroll in Medicare before the age of 65 |
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Respite Care |
Temporary hospitalization of a terminally ill patient to provide relief for the nonpaid caregiver |
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Medicare Select |
Medigap insurance that requires enrollees to use a network of providers |
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What happens when a patient selects hospice care? |
All other benefits stop with the exception of physician services for treatment for conditions not related to the patient's terminal illness |
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How many lifetime reserve days are there? |
60 |
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Medicare Advantage |
Managed care and private fee for service plans provided to Medicare patients |
