MEDICARE /MEDICAID
A replacement insurance for Medicare
What is a Medicare Advantage Plan?
Amount that a person with health insurance is required to pay at the time of each visit
What is a copay?
There is no wrong way to eat a _________
What is Reese's Peanut butter cups?
Portal used to verify Tricare plans.
What is Availity?
This is in addition to MCR to help cover costs such as AARP
What is a Medicare supplemental plan?
Preferred provider organization
What is a PPO?
Taste the rainbow
What are Skittles?
Specific 12 month period during which benefits are calculated.
What is a plan year?
Public health insurance that provides healthcare coverage to low income families/individuals
What is Medi-Caid (or Medi-Cal)
Required from 3rd party payors to provide specified care in a particular setting; written or electronic assurance that the services provided will be covered under the terms of the patient’s health care plan?
What is an authorization?
It's a juicy contradiction
What are Starbursts?
Current Procedural Terminology codes
What are CPT codes?
Hospital coverage only.
What is Medicare Part A?
Person in charge of managing claims/authorizations
Who is a claim manager/adjuster?
Get the sensation
What is a York peppermint patty?
The process of obtaining approval for medical services that have already been delivered.
What is a retro authorization?
65 years old. Disabled person.
End stage renal disease.ALS
Who is eligible for Medicare
Law that allows patients to seek physical therapy services without a prescription or prior referral from a physician. Regulations & limitations vary by state.
What is Direct Access?
Try both and pick a side
What are Twix?
Process used by insurance companies to determine which plan pays 1st when a pt. has multiple health plans.
What is coordination of benefits?