Medicare Chpt 9

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anyone over age 65 who receives social security benefits is automatically enrolled in
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Medicare. parts A and B
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retired federal employees who are enrolled in the civil service retirement system are eligible for
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Medicare benefits and their spouses
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Medicare part A is also called
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hospital insurance
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care in a skilled nursing facility is covered under
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Medicare Part A
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Medicare part C was originally called
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Medicare+ choice
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Medicare Part B provides
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voluntary Medicare prescription drug plans
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Each Medicare enrollee receives
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a Medicare card issued by the Social Security Administration
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CWF stands for
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Common Working File
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Medicare Part B does not provide benefits for
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cosmetic surgery
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ABN is the abbreviation for
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Advance Beneficiary Notification
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the modifier GY is appended to procedure codes for
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noncovered Medicare services when the item is excluded and an ABN is not required
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physicians who do not participate in the Medicare program do not accept
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the Medicare Fee Schedule charge amount as full payment for services
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115% of the fee on the Medicare NonPAR fee Schedule equals
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the limiting charge
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under the Medicare program, a nonparticipating physician may not kill more than 115% of the approved charge on the nonPAR fee schedule
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the Medicare limiting charge is
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the highest fee that can be charged for a procedure by a nonparticipating provider
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Patient receive a Medicare Summary notice(MSN) that
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details the services they were provided over a thirty day period. the amounts charged, and the amounts they may be billed
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Medicare Advantage offers three types of plans including
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Medicare private fee for service plans. Medicare coordinated care plans (CCP’s) and Medicare Savings Account (MSA)
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urgently needed care is defined in the
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Medicare program as unexpected illness or injury that requires immediate treatment
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Medigap offers
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fill in the gap insurance
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All laboratory work paid by Medicare is regulated by
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CLIA rules
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CLIA is administered by
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CMS
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Services supervised by the physician but provided by nonphysician practioners are billed
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under incident to rules ex: physician assistant or nurse practioner
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roster billing applies to
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Part B claims
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a screen service is performed for a patient who
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does not have symptoms, abnormal findings or any past history of the disease
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people who are over the age 65 but who are not eligible for free Part A coverage may enroll by
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paying for premium

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