Forms
A notice that a care provider should give a Medicare beneficiary to sign if the services being provided may not be considered medically necessary and Medicare may not pay for them.
ABN
Advance Beneficiary Notice
The parent whose birthday falls earliest in the calendar year becomes the primary insurance and the other would be secondary.
Birthday Rule
Medicaid, Medicare, Tri-care/Champus are considered what kind of health insurance plans?
Government plans
To be eligible for medicare one must be...
age 65 or older
Disabled
ESRD end stage renal disease
established by federal legislation in 1965 to provide healthcare coverage for certain low-income people.
Medicaid
A written instruction relating to the provision of healthcare when a patient is incapacitated. It may include appointing someone to make medical decisions, a statement expressing the patient’s wishes about anatomical gifts (i.e. organ donation), and general statements about whether or not life-sustaining treatments should be withheld or withdrawn.
Advance Directive
Husband has insurance through his employer and he is also covered by his wife's employer. Which insurance should is primary and which is secondary for his medical visits?
His insurance plan from his employer is primary and the insurance that he has from his wife's employer is secondary.
Anthem, Cigna, BCBS, Aetna are considered what kind of health insurance plans?
Commerical Plans
What does Medicare part A benefits cover?
Inpatient Services
Healthcare organizations contract with the HMO to provide services to Medicaid recipients.
Which type of Medicaid is this?
HMO Medicaid
A consent given in writing where by a patient acknowledges that they have been informed about the planned procedure including the risks involved. It is required for any operative or invasive procedure as well as for participating in any research protocol. In order for a patient or family to truly understand, they must be given a clear explanation by the provider of any proposed treatments or procedures including.
Informed Consent
The patient has two health plans. One is Aetna from her job and the other is Caresource Medicaid. Which insurance plan is primary and why?
Aetna. Medicaid is the payer of last resort.
What number is used to identify a patient on their insurance card?
Subscriber ID or Member ID #
A private insurance that is designed to help pay Medicare cost-sharing amounts such as Medicare's coinsurance and deductibles, and uncovered services.
Medigap Insurance
a program available to qualified adult children for purchase after their TRICARE coverage ends.
TRICARE Young Adult
Consent by law when a patient presents unconscious to the Emergency Department
Implied Consent by Law
Wife has insurance through her employer and she is also covered by her husband's employer. Which insurance should is primary and which is secondary for her medical visits?
Her insurance plan from her employer is primary and the insurance that she has from her husband's employer is secondary.
What kind of medicare plan includes RX ?
Medicare advantage plan
The number of days that Medicare covers care in hospitals and skilled nursing facilities is measured in ___________
Benefit Periods
_________ is used for injuries that are the result of negligence of another party
Liability Coverage
“consent by silence” as implied by no objection
Implied Consent (in fact)
The patient has two health plans. One is Cigna from her job and the other is Tricare. Which insurance plan is primary?
Cigna
Subscribers can add whom to their insurance plan?
Spouse and Children.
Medicare will pay for an additional 60 days of hospitalization when a beneficiary is an inpatient in a hospital for greater than 90 days.
Lifetime Reserve Days
_________ is often the primary insurance for injuries that are the result of an automobile accident.
Auto Insurance