Exam (elaborations) CHAA551

Medicare - ANSWER The federal health insurance program for: − People age 65 and older − People of any age with end stage renal disease − Certain disabled people under age 65 Medicare Prefix A - ANSWER A - Primary wage earner Medicare Prefix B - ANSWER B - Entitled to benefits through spouse Medicare Prefix C - ANSWER C - Child Medicare Prefix D - ANSWER D - Widow Medicare Prefix D1 - ANSWER D1 - Widower Medicare Prefix W - ANSWER W - Disabled widow Medicare Prefix W1 - ANSWER W1 - Disabled widower Medicare Part A - ANSWER Hospital Insurance (Part A) helps pay for inpatient hospital services, skilled nursing facility services, home health services, and hospice care Medicare Part B - ANSWER Medical Insurance (Part B) helps pay for doctor services, outpatient hospital services, medical equipment and supplies, and other health services and supplies. Medicare Part C - ANSWER Medicare Part C is a Medicare Advantage plan. These are private insurance companies offering plans, mostly to seniors, such as HMOs and PPOs Medicare Part D - ANSWER Medicare Part D (Medicare Prescription Drug Coverage) helps cover prescription drugs. (This coverage may lower your prescription drug costs.) Carriers and Fiscal Intermediaries - ANSWER Private insurance organizations called Medicare carriers and fiscal intermediaries handle claims and interpret reimbursement regulations under the Original Medicare Plan. Medicare Covered Services - ANSWER Medicare (Part A) Hospital Insurance helps pay for necessary medical care and services furnished by Medicare-certified hospitals, skilled nursing facilities, home health agencies, and hospices. Inpatient Hospital Care - Medicare Part A - ANSWER helps pay for up to 90 days of inpatient hospital care in each benefit period. Covered services include semi-private room and meals, general nursing services, operating and recovery room costs, intensive care, drugs, laboratory tests, X-rays, and all other necessary medical services and supplies. Pre-admission Diagnostic Services - ANSWER Medicare's three day (AKA: 72 Hour) Rule requires that pre-admission testing and diagnostic services provided to a beneficiary by the admitting hospital within three days prior to the admission are included in the inpatient payment. They are not to be billed as separate outpatient charges unless there is no Part A coverage. For example, if a patient is admitted on a Wednesday, services provided by the hospital on Sunday, Monday, or Tuesday are included in the inpatient Part A payment. This provision includes visits to the Emergency department but does not apply to ambulance services. Benefit Periods - ANSWER The number of days that Medicare covers care in hospitals and skilled nursing facilities is measured in benefit periods. A benefit period begins on the first day of services as a patient in a hospital or skilled nursing facility and ends 60 days after discharge from the hospital or skilled nursing facility provided that 60 days has not been interrupted by skilled care in any other facility. There is no limit to the number of benefit periods. The beneficiary must pay the inpatient hospital deductible for each benefit period. Life Time Reserve Days - ANSWER Medicare will pay for an additional 60 days of hospitalization when a beneficiary is an inpatient in a hospital for greater than 90 days. The 60 days can be used only once in a lifetime. For each lifetime reserve day, Med