MCR Parts
Part _____ of Medicare includes Medicare Advantage options
WHAT IS PART C
A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is
what is Medicare
The acronym for the Medicaid program that was formerly referred to as AFDC is
WHAT IS TANF
A combination federal/state medical assistance program that provides comprehensive and quality medical care for certain categories of low-income and qualifying elderly people is
What is Medicaid
When an individual is covered under both Medicaid and Medicare and/or a private healthcare policy, the payer of last resort is always
what is Medicaid
Part _____ of Medicare helps pay for charges incurred during an inpatient hospital stay.
Individuals pay for Medicare Part B coverage through
what is monthly premiums
When it is likely that Medicare will not pay for a service or procedure that Medicare ordinarily covers but is likely to be denied on this particular occasion, the patient should be asked to sign a/an
WHAT IS ABN
To qualify for supplemental security income (SSI), individuals must meet certain financial guidelines set by
what is Federal Poverty Level
The Medicaid program is administered by
WHAT IS CMS
Part _____ of Medicare helps pay for physician and outpatient charges
WHAT IS B
The duration of time during which a Medicare beneficiary is eligible for Part A benefits for inpatient hospital or skilled nursing facility charges is called a/an
what is benefit period
Medicare’s fee schedule is based on a system whereby each payment value is found within a range of payments known as
What is RBRVS
Medically needy individuals can reduce their assets to the Medicaid eligibility level by deducting medical expenses; this is called a/an
what is spend down
An individual who is eligible for both Medicare and Medicaid programs is said to be a/an
what is dual eligible
Part _____ of Medicare helps pay for prescription drugs.
WHAT IS D
When a service or procedure meets Medicare’s criteria for coverage, it is said to be
what is medically necessary
The act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness is
what is CLIA
Individuals who receive medical assistance because their income falls within the poverty or FPL guidelines or as a result of SSI eligibility are considered
what is categorically needy
There are _____ levels to the Medicare appeals process
what is 5
There are _____ parts to the Medicare program.
WHAT IS 4
The term used when Medicare is not responsible for paying first because of coverage under another insurance policy is
what is Medicare Secondary Payer
The job of a ______________________ is to detect and correct past improper payments so that CMS and MACs can implement actions that will prevent future improper payments.
WHAT IS RAC (recovery audit contractor)
Before providing services to patients claiming to be on Medicaid, the health insurance professional should
what is verify eligibility
An individual is generally not eligible to select a Medicare Advantage plan if he or she has been diagnosed with _________.
what is ESRD