Enrollment
Patients can go to this building to enroll in Medicare.
What is the Social Security Dept.
Type of Medicare that covers Inpatient Care.
What is Part A.
Includes all benefits and services covered under Part A and Part B. Is run by Medicare-approved private insurance companies. Usually includes Medicare prescription drug coverage (Part D) as part of the plan. May include extra benefits and services for an extra cost.
What is Medicare Part C (Medicare Advantage)
Is also known as Medicare Drug Coverage.
What is Part D
Includes obtaining a benefit through intentional misrepresentation or concealment of material facts
What is Fraud
It is a 7-month period that begins 3 months before you turn 65, and ends 3 months after the month you turn 65.
What is the Initial Enrollment Period (IEP)
The deductible amount that patients pay for Hospice.
$0
True or False. You must have Part A and Part B to join a Medicare Advantage plan
What is True
True or False. To join a Medicare Drug Plan, you must have Part A and Part B.
What is False. You can have Part A or Part B.
A local surgeon offers to pay you $500 for each patient you refer to her clinic. This is an example of which fraud and abuse law?
What is the Anti-Kickback Statute
If you didn't sign up for Part B or Part A during your IEP and you don't qualify for a SEP, you can sign up during this period.
What is General Enrollment Period.
Name at least three services that part B covers.
What is Doctor visits and treatments
Diagnostic tests and X-rays
Emergency Room charges
Outpatient clinic charges
Labs
Durable medical equipment
Name the four coverage stages of a Part D plan
What are Deductible Stage, Initial Coverage Stage, Coverage Gap ("Donut Hole), and the Catastrophic Coverage Stage
You and your physician partners just took an investment course and decided to invest in a local rehab center. Everyone in your practice begins to refer any patient who needs rehab to the rehab center you invested in. What type of fraud and abuse law are you breaking?
Physician Self-Referral Statute
The general enrollment period for Medicare.
What is January 1 - March 31
The amount the patient must pay each calendar year before Medicare begins to pay.
What is the Yearly Deductible.
This type of Medicare Advantage plan requires you to use doctors, hospitals, and labs that are in network, and to see a specialist you must first see your PCP.
What is an HMO
During the Coverage Gap aka "Donut Hole" you pay this percentage of the price for covered brand-name drugs and covered generic drugs.
What is 25%
You've just received the "financial death sentence". What does this mean?
Exclusion from Medicare and Medicaid - excluded physicians may not bill for treating Medicare and Medicaid patients, nor may their services be billed indirectly through an employer or a group practice.
Name all five enrollment periods were you can enroll in a Medicare Advantage plan
Initial Enrollment Period (IEP)
General Enrollment Period (GEP) Jan 1 - March 31
Special Enrollment Period (SEP)
Yearly Open Enrollment Period (OEP) Oct 15 - Dec 7
Medicare Advantage Open Enrollment Period (MOEP)
Name five services not covered by Part A and Part B
Most Dental Care Acupuncture
Eye exams related to glasses Hearing Aids
Dentures Concierge Care
Cosmetic surgery Massage therapy
The Medicare Advantage Open Enrollment Period is available from these dates
January 1 - March 31
In 2023, you will automatically get catastrophic coverage after you've spent this amount.
What is $7400
Name the five Federal Fraud and Abuse Laws most relevant to physicians
What are False Claims Act, Anti-Kickback Statute, Physician Self-Referral Statute, Exclusion Statute and Civil Monetary Penalties Law