Part A and B
What is the General Enrollment Period?
The period each year when you can sign up for Medicare Part A and/or Part B, if you chose not to sing up when first eligible or if you missed your Special Enrollment Period.
What does MAPD stand for?
What can/can't someone do if they have an authorization to disclose on file?
Cannot Change Address, Cannot change plan, can release general info only
What is sad?
Self administered drugs
What are examples that help assist with low income?
Aunt Bertha,my advocate, extra-help, LIS
This ends when a patient is discharged from a hospital or SNF for 60 consecutive days.
What is a benefit period
Is it true that you must have Part D to have the MAPD plan? Yes or No
Yes
What do we need from a provider?
NPI or TIN #
What is Tier 5?
Specialty drugs (compound drugs)
Part C may be prohibited due to?
Illness or Sanctions
What do you have to purchase as well when you have Part A?
What is Part B?
Under what conditions can a member of a Medicare Advantage Plan go outside a network of providers without paying the bill out of pocket?
To receive emergency services.
If deceased what form would we use?
CONE
What's another word for a "take-back"?
Recoupment
Medicare claims will not process unless it has ___
002
If you don't have medicare Part D, but have A, B & C, what will happen?
Member will be penalized 1% m/o (LEP)
What 4 things did david tell us about MAPD?
It's greater/equal in benefits, has dental, vision, etc, has to have part D, and it has a copay
Who do we never refer or transfer a member to?
Traditional medicare or medicare
What system is the ultimate source of truth for LIS info?
MARX
What commercially available vaccines does PART D MUST cover?
The Shingles
Medicare pays for most inpatient hospital care under what payment system?
What is Prospective Payment System
When is the AEP for this?
January 1st - March 31st
What are revenue codes used for?
Do new members with ERSD usually get original medicare? Yes or No?
Yes
Explain the LEP calculation process for Part D
Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.19) x the number of full, uncovered months they didn't have part D or credible coverage. The number is rounded to the nearest 10 and added to the monthly part D premium
EX : 33.19 x 1% = 0.3319 x 5 months = $1.70 m/o