CMS 1500
if the pt and insured are the same; what do I do on the claim form ?
only enter name in the insured box - not needed in pt box
what does the insurance send to the patient with details of the processed claim?
EOB
what book do we use to find diagnosis codes?
ICD-10
describe a benefit period (be specific)
1st day of hospitalization until 60 days out
What is the primary goal of PACE program
to keep elderly people in their homes and active in community activities
what do I put in Box 12 to indicate the pt assigned benefits to provider?
SOF; signature on file or actual signature
what does the insurance send to the provider office with details of processed claims?
RA (remittance advice)
what book do we use to find procedure codes ?
CPT
Which part of Medicare covers eye exams, hearing and dental ?
Part C
explain dual eligibility
when pt qualifies for both medicare and medicaid
what is the importance of the diagnosis pointer?
proves medcial necessity
what is the term that means the provider is ultimately responsible for the employees actions?
respondent superior
National codes are part of which coding system?
HCPCS
what is the written documentation a patient must sign before a procedure is done when it is expected that medicare will not pay for it ?
ABN (advanced beneficiary notice)
what are the 2 eligibility groups for medicaid?
medcially needy and special groups
what do we put in Box 24 ?
Cpt codes (procedures)
what type insurance protect against actions and failure to act?
bonding
what form (electronic) is used ot report inpatient hospital claims ?
UB-04
what is the total number of medicare lifetime reserve days?
60
Name 3 things the community spouse can retain during spousla impovershment action
house
car
prepaid burial
some $$$
jewelry
what goes on Box 21 ?
ICD 10 codes or diagnosis codes
what is the list of predetermined payments that will be made to healthcare providers called?
physicians fee schedule
what book do we use to report inpatient hospital claims?
ICD-PCS
Pt is 46 and receives a social security disability. what parts of medicare do they automatically receive - and after what period of time after they began to recieve the disabilty are they enrolled?
Part A and B / 24 months
name 3 medicaid "services' that are not mandated by the government but may be added by each state if they choose to .
pg 536 handout (there are 28 of them)