Empfohlen
Weitere ähnliche Inhalte
Was ist angesagt?
Was ist angesagt? (20)
Andere mochten auch
Ähnlich wie Chapter 12 HIT 212
Ähnlich wie Chapter 12 HIT 212 (20)
Kürzlich hochgeladen
Kürzlich hochgeladen (20)
Chapter 12 HIT 212
- 2. Regulated by Centers for Medicare and Medicaid Services (CMS) Eligibility 65+ years and retired on Social Security 65+ years and retired on Railroad or Civil Service Disabled Child/adult with kidney disease Kidney Donor Medicare
- 3. Medicare Part A Covers hospital services No Charge Usually primary payer Medicare Part B Covers outpatient services Paid for by recipient Includes physician charges Two types of Medicare Benefits
- 4. Benefit period starts when the patient is admitted and ends when the patient has not been in an acute care hospital or nursing home bed for 60 consecutive days Will pay for up to 100 days of skilled care Must have had at least a 3 day stay at a hospital Medicare Part A: Hospital Benefits
- 5. Supplemental medical insurance Patient has to pay a premium Medicare Part B: Medical & Preventative Care Benefits
- 6. Medicare Part C Benefits are paid monthly Covers both A & B services Medicare Part D Covers prescription drugs Additional Medicare Coverage
- 7. Railroad Retirement Benefits Employed Elderly Benefits Medicare/Medicaid Medicare/Medigap Managed Care plans Additional Medicare Coverage Continued
- 8. Risk plan Only receive Medicare covered services from provider who are contracted member of HMO network – restricted beneficiaries Cost Plan Receive Medicare covered services from providers outside of the HMO network – unrestricted beneficiaries Medicare Managed Care Plans
- 9. Quality Improvement Organization Federal False Claims Amendment Act Health Insurance Portability and Accountability Act Civil Monetary Penalties Law Stark I and II Regulations Clinical Laboratory Improvement Amendment Utilization and Quality Control
- 10. Payment Fundamentals Participating Non-Participating
- 11. Establish medical necessity Substantiate why patient needs service Prepayment screens PRIOR AUTHORIZATION
- 12. DRGs HCPCS CPT RBRVS Medicare Reimbursement
- 13. Fiscal intermediaries/MACs National Provider Identifier (NPI) Signature on File (SOF) Electronic submission Cross over claims Claim Submission
- 14. Explanation of Benefits (EOB) After Claim Submission