Medicare Terms
CMS
Center for Medicaid and Medicare Services
What KA lets me know where I can find the Mentor line phone number/VDN number?
Knowledge - Medicare Member : Phone Numbers and Mailing Addresses
What is the system we use to REVIEW Grievances/Appeals?
MEDHOK (MHK)
What type of information do you have to verify before changing a member's preferences and/or change address?
Medicare Beneficiary Identification Number (MBI)
TRUE or FALSE: Resources for Living can assist members with Food Aid.
TRUE
PREMIUM
The fixed monthly amount you pay to the plan to keep your coverage active.
What KA lets me know hat to do if a members name is incorrect?
KnowledgeMedicare Member: Name Changes (2601)
What is the system that we use to see members Case Management Information, Prior Authorizations, Diagnosis, etc. ?
MedCompass
What is the primary function of Medicare Part C, also known as Medicare advantage ?
It combines the benefits of Medicare Parts A and B, and sometimes D.
TRUE or FALSE : You should only access protected health information in any system if you have business to do so.
TRUE
HMO
Health Maintance Organization
What KA can help you outreach Dual Special Needs Plan Care management?
Medicare Member Dual Special Needs Plan (DSNP) Case Management (CM) (3750)
What is the system OR systems we use to see the member LIS/PART A and B Eligibility/LEP and Enrollment information?
Market Prominence & MARx
Which of the following services is covered under Medicare Part A?
Inpatient Hospital Care
Medicare and Medicaid are the same.
FALSE : Medicare is federal health insurance program while Medicaid is a joint federal and state program for people with low income.
PPO
Preferred Provider Organization
What KA can tell me more information about Extra Help (Low Income Subsidy) ?
Medicare Member: Low Income Subsidy (LIS) Call Handling KA (4446)
What systems do we use to view Procedure Code Inquiries ?
RUMBA
What is the Primary purpose of Medicare Part D?
To serve as a prescription drug program for Medicare Beneficiaries
FALSE: Preventive services include routine screening vaccines and annual wellness checks.
MIB
Medicare Beneficiary Identifier
What KA can help me with a member who recently lost part A and part B eligibility ?
Medicare Member - Reinstatement Workflow for Loss of Medicare Entitlement (Part A, B or D) - Call Handling
(2812)
What is the main system we use for our phone system, View Members information, Claims, Communications and allow us to order member's materials?
GPS
What is the law that is violated if a healthcare provider shares patients medical information without consent?
HIPAA
The four parts of Medicare coverage are Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage).