Coverage
What day(s) are not counted when it comes to calculating the benefit period?
What is The date of discharge )?
Unlike with Part B, this must be paid every new benefit period.
What is the Part A deductible?
The beneficiary, provider, supplier, or appointed representatives have the right to do this whether a claims for services were paid or denied.
What is File an Appeal?
Rights you have in certain situations when insurance companies must sell you certain Medigap policies.
What is guaranteed issue rights, also called Medigap protections?
Where in NGD can you locate the beneficiary’s claim information?
What is the Claims view?
How long must the beneficiary be out of an inpatient facility for the Part A deductible to reset?
What is 60 consecutive days ?
This helps cover the costs that Original Medicare doesn't cover
What is a Medigap policy or supplemental insurance plan?
This can only be completed if the open MSP record is listed as "Working Aged".
What is Simple Termination?
This contractor is responsible for collecting, managing, and reporting other insurance for Medicare beneficiaries, determining primary & secondary payors, & recovering payments Medicare made when other insurance was primary.
What is Benefits Coordination & Recovery Center (BCRC)?
If a beneficiary does not agree with the processing of a claim, what recourse do they have?
What is file an appeal?
What is Home Health Services?
This benefit provides reduced or no premiums and deductibles and reduced copayments for prescription drugs.
What is Extra Help?
These are administered by state medical assistance programs for people who need help paying for Medicare expenses.
What are Medicare Savings Programs?
Plans for people with Medicare who have a severe or disabling chronic condition, such as diabetes, end-stage renal disease (ESRD), HIV/AIDS, chronic heart failure, or dementia.
What is Chronic Special Needs Plan?
A program that offers free, in-depth, one-on-one counseling and assistance to beneficiaries and their families, friends, and caregivers via phone or in-person.
What is a SHIP counselor?
Your provider or supplier gives you this form when they think that Medicare won’t pay for an item or service because it is not medically reasonable or necessary.
What is an Advance Beneficiary Notice of Noncoverage, also known as an ABN?
This amount goes up 10% for each full 12-month period you could have had Part B but did not sign up
What is Late Enrollment Penalty (LEP)?
If you have these protections, the insurance company must sell you a policy, must cover all preexisting health conditions, & can't charge you more due to any past or present health conditions.
What are Guaranteed Issue Rights?
When Medicare sends a beneficiaries claim payment information to their supplemental insurance company
What is Supplemental Crossover of Claims?
How many levels of appeals are available to the beneficiary
What is 5 Levels?
Medicare generally doesn't cover this type of care, often referred to as custodial care.
What is Long-Term Care (LTC)?
The amount the beneficiary must pay per day after 60 days of inpatient care is called this.
What is daily coinsurance?
Unable to be used for SNF stays, the beneficiary is limited to 60 of these and once used, they do not renew.
What are Lifetime Reserve Days?
When a beneficiary has other insurance that pays their healthcare bills before Medicare
What is Medicare Secondary Payer?
What type of information is contained in the State Program History list applet at the bottom of the Other Insurance view?
What is Medicare saving program enrollment?