WORKER'S COMP
What are the 4 types of worker's comp benefits?
Medical, Income, Death and Burial
What is covered under Part A of Medicare?
Inpatient hospital care
Inpatient skilled nursing facility
Home Healthcare
Hospice
Blood
Organ Transplant
What goes in box (locator) 1a. ?
Insured's I.D. number.
What is Managed Care Organization?
An organization designed to provide healthcare that is cost effective.
Until what age are children eligible to be a beneficiary of a worker's comp claim?
Until age 18 or until age 25 if enrolled full time in an accredited college.
Who is the Social Security Administration (SSA) ?
They collect Medicare premiums and maintain the Medicare master beneficiary record.
What goes in box (locator) 11c. ?
Insurance plan name or program name.
What does HMO stand for?
Health Maintence Organization
What is the Federal Employees Compensation Act (FECA) ?
Provides benefits to millions of civilian employees of the U.S, members of the Peace Corps, and Vista volunteers
What is the Benefit Period?
A period of time during which medical benefits are available to an insurance beneficiary.
What is located in the first section of the CMS 1500 form,boxes 1-13?
Patient and Insured information.
What are the 3 major types of managed care plans?
Health Maintenance Organizations
Preferred Provider Organizations
Point-of-Service Plans
What programs are administered by the Office of Worker's Compensation Programs (OWCP) ?
Federal Employees Comp. Act, District of Columbia Worker's Comp. Act, Longshore and Harbors Worker's Comp. Act, and Energy Employees Occupational Illness Act.
What is covered by Part B of Medicare?
Physician Services
Outpatient hospital services
Emergency department
Diagnostic testing.
A medical group or solo practice must have one of these two things?
An Employer Identification Number (EIN) or a Tax Identification Number (TIN).
Out of all the Managed Care Organizations, which is the most restrictive type of health care?
Health Maintenance Organization (HMO)
What are the 5 types of work-related, injury classifications?
Injury without disability
Injury with temporary disability
Injury with permanent disability
Injury requiring vocational rehabilitation
Injury resulting in death
What is the Original Medicare Plan or Fee-for-Service?
A method of reimbursement that pays the provider for their standard charge for each procedure.
If box #20 is checked yes, what information goes in box #32?
What are the 5 group types of HMO's?
Group Model, Individual Practice Association, Network Model, Staff Model and Open Access