Facts
What are parts A & B?
Part of Medicare that covers prescription drug.
What is part D?
Age requirement for traditional coverage.
What is 65?
The first level of Medicare appeal.
What is redetermination?
Written waiver of liability issued when a service may not be covered for a Medicare patient.
What is an ABN?
Timely filing limit for Medicare claims.
What is one year?
Part that is administered by commercial/private payers.
What is part C?
Part of Medicare requiring additional premium for coverage.
What is part B
The second level of Medicare appeal.
Unique 10-digit provider ID number required by HIPPA.
What is an NPI?
Administration Simplification Compliance Act (ASCA) requires this type of claim billing.
What is electronic?
Part of Medicare that covers DME, physician, and lab services.
What is part B?
Patients requiring dialysis, ESRD/renal failure, and/or transplant qualify under this provision.
What is disability?
The third level of Medicare appeal.
What is administrative law judge?
Health care insurer in geographic jurisdiction processing Medicare Part A and B medical claims.
What is a Medicare Administrative Contractor (MAC)?
Period of time provider cannot submit patient claims after "opting out" of Medicare.
What is two years?
Part of Medicare that covers inpatient hospital care.
What is part A?
Entitlement time period under Social Security disability needed for Part A coverage.
What is 24 months?
The fourth level of Medicare appeal.
What appeals council?
Simplified practice of billing one claim for multiple patients receiving immunizations.
What is roster billing?
Term to describe mid-level provider billing under the physician as if performed by the physician.
What is "incident to"?
Part of Medicare that typically requires no additional premium to beneficiaries.
What is part A?
Part B coverage can be deferred with working-aged coverage through current employment under this provision.
What is Medicare Secondary Payer (MSP)?
The final level of Medicare appeal.
What is judicial review?
Limiting charge/percentage of fee schedule allowed to non-par providers on unassigned claims.
What is 115%?