RAINBOW RUMBLE

A

1

What are the 4 parts of Medicare and its coverage

Part A- Inpatient Services

Part B- Outpatient Services

Part C- Medical Advantage Plan

Part D- Prescription

2

What are the Eligibility Criteria to qualify for Medicare

* 65 and above

* Disability

* people with ESRD

3

It is a Federal Payer for People with Lower income

Medicaid

4

It is a way to qualify for Medicaid even if their income is higher than the state's Medicaid limit

Spend down

5

What is Medicare TFL?

1 years starting from DOS

B

1

A percentage of the charges that the patient is responsible for paying

Coinsurance

2

The maximum amount a patient will be asked to pay out of pocket per year.

Out of pocket maximum

3

These are codes assigned to determine the illness of the patient

ICD-10 codes or diagnosis codes

4

The Person who is financially responsible for the Medical cost.

Guarantor

5

It is a Tricare Plan for active military personnel 

Tricare Prime

C

1

what does PCP stand for?

Primary Care Physician

2

what does RCM stand for?

Revenue Cycle Management

3

Two-digit codes to indicate the setting in which a service was provided or performed

POS or Place of Service

4

TRUE/FALSE: Cosmetic surgery is part of Medicare covered service

False

5

It is sometimes called “Medicare Supplemental Insurance.” They pay for the “gaps” in Medicare coverage

Medigap

D

1

It is a Healthcare program for the US Department of Defense military health system

Tricare

2

This determines which insurance is primary when the patient has multiple insurances

Coordination of benefits (COB)

3

It usually refers to the plan that is taken by the patient in his/her state where the patient resides& pays premium. This usually applies for BCBS card holders with Blue card eligibility

Home Plan

4

Amount that must be paid and met before the insurance kicks in

Deductible

5

It is a healthcare program for veterans

CHAMPVA

E

1

Fixed dollar amounts associated with a type of visit (ER, office visit, or a diagnostic test)

Copay

2

The person in whose name an insurance policy is written. Also referred to as the insured or subscriber

Policy holder

3

A type of commercial plan that only covers in network providers only

HMO

4

True or False:

Medicaid should be renewed quarterly

False

5

The process used by health plans to assess the medical necessity & appropriateness of medical treatment requested by a physician for a patient. It is a clinical review required by some Health Insurance carriers before a service is rendered.

Authorization/ Prior Authorization