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| originally covered for hospital service |
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| plans for physician services |
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| usual, customary, and reasonable |
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| form of prospective authorization |
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| Health insurance specialist should re-bill any BCBS claims not paid within |
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| covers bills relating to institutional providers for inpatients, hospice and home health |
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| no cost to individuals 65 or older,and who currently receive retirement benefits from Social Security,but have not applied for benefits and had Medicare-covered government employment |
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| Non participating physicians may elect to accept assignments on a |
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| an easy to read monthly statement that clearly lists health insurance claims information for beneficiaries |
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| created to assist beneficiaries with outpatient prescription drug cost |
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| allowed to charge 15% more than a PAR provider for covered services |
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| must notify beneficiaries in writing of projected out-of-pocket costs for elective surgery and noncovered procedures when the charge is $500 or more |
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| balance billing of Medicare patients is |
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| Patients facing an emergency or urgent health situation cannot be asked by a provider to sign a |
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| state administered and federally mandated |
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| Medicaid programs very from |
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| Government assistance program |
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Definition
| Medicaid is a program designed to help individuals with medical expenses |
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Definition
| Medicaid eligibility has to be verified at each |
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Term
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Definition
| All Medicaid recipients must pay a monthly premium |
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Term
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Definition
| What are Medicaid recipients required for some categories to do? |
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Term
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Definition
| Individuals classified as medically needy have out-of-pocket expenses |
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| Temporary Assistance for Needy Families (TANF) |
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Definition
| provides time-limited cash assistance for children deprived of support because of a parent's death, incapacity, absence, or unemployment |
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Definition
| will pay the Medicare premium, deductible, and coinsurance for qualified Medicare beneficiaries (QMB) with low monthly income and limited resources |
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Definition
| Medicaid reimbursement information sent to the provider is called the |
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Term
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| Additional health and liability programs are never considered primary to Medicaid |
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| What must be attached by the primary payer when filing a Medicaid secondary claim |
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| How many TRICARE regions are located in the US |
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Definition
| A health care program of active duty members of the military and their qualified family members,CHAMPUS-eligible retirees and their qualified family members, and eligible survivors of members of the uniformed services |
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Definition
| A benefit that was put into effect ot protect beneficiaries from devastation financial loss due to serious illness or long-term treatment |
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| similar in design to a civilian HMO |
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Definition
| is a preferred provider organization (PPO) |
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| is a fee-for-service option |
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| Annual enrollment is not necessary for TRICARE Extra |
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| Allows the greatest freedom in selection civilian providers |
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Term
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Definition
| Providers may enroll in TRICARE Standard on a |
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| NAS nonavailabilty statement |
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Definition
| is a certificate issued at a treatment facility when a particular service cannot be performed at a military treatment center |
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Definition
| TRICARE is secondary to commercial medical insurance policies |
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| survivors of veterans who died in the line of duty (without misconduct) would be eligible for |
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| Federal Black Lung Program |
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Definition
| A program designed to provide medical treatment and other benefits for respiratory conditions related to former emplyment in a coal mine is |
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Definition
| working while impaired by an illicit drug would preclude an employee from receiving workers' compensation benefits with an on-the-job injury |
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Definition
| What was enacted by congress to protect employees against injuries from occupational hazard in the workplace |
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| MSDS (Material Safety Data Sheets) |
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Definition
| obtaining and retaining is a OSHA requirement |
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Definition
| Employees who, during the normal course of their job may come into contact with human blood and other potentially infectious materials must be offered the |
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Definition
| Who carries the burden of the cast and is responsible for paying workers' compensation premiums |
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Definition
| the employer must be contacted immediately by the treating provider to ensure proper handling of all job-related injuries or conditions |
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Definition
| Who is responsible for completing the First Report of Injury form |
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Term
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Definition
| the filing deadline for completing the First Report of Injury is the same from state to state |
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Definition
| The patients signature is not required on the workers' compensation claim |
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Definition
| If the workers' compensation carrier requests further medical information about the claim who provides that information |
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Definition
| If a patient's workers' compenstion claim is denied, the patient is allowed fot file an appeal regarding the denial |
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