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| originally covered for hospital services |
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| The abbreviation UCR stands for |
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| usual, customary, and reasonable |
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| a form of prospective authorization |
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| varies according to the plan in which the patient is enrolled |
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| The health insurance specialist should re-bill any BCBS claims not paid within |
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| covers a specific portion of patients' bills relating to institutional providers for inpatients, hospice, and home health |
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| Medicare Part A is available at no cost to individuals |
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| age 65 or older and who currently receive retirement benefits from Social Security, qualify to receive retirement benefits from Social Security but have ot yet applied for benefits and had Medicare-covered government employment |
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| Medicare nonPAR physicians may elect to accept assignment on |
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| The Medicare Summary Notice is |
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| an easy-to-read monthly statement that clearly lists health insurance claims information for beneficiaries |
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| Medicare part D plan was created in part to |
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| assist beneficiaries with outpatient prescription drug costs |
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| Medicare non-participating providers (nonPARs) are allowed to charge |
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| 15% more than a PAR provider for covered services |
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| NonPAR physicians and surgeons must notify beneficiaries in writing of |
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Definition
| 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 connot be asked by a provider to sign a |
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| state administered and federally mandated |
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| State Medicaid programs vary from |
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| Medicaid is a government assistance program designed to help |
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| individuals with medical expenses |
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| Medicaid eligibility has to be verified at each |
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| Not all Medicaid recipients must pay a |
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| Copayments are required for some categories of |
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| Individuals classified as medically needy have |
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| Temporary Assistance for Needy Families (TANF) provides time-limited cash assistance for |
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| children deprived of support because of a parent's death, incapacity, absence, or unemployment |
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Term
| State Medicaid programs will pay the Medicare premium, deductible, and coinsurance for qualified Medicare beneficiaries (QMB) with |
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Definition
| low monthly income and limited resources |
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Term
| Medicaid reimburesement information sent to the provider is called the |
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| Additional health and liability programs are always considered primary to |
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| When filing a Medicaid secondary claim, the remittance advice fromt he primary payer must be |
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Term
| There are 3 TRICARE regions located in |
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Term
| The catastrophic cap benefit was put into effect to protect beneficiaries from |
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| devastating finacial loss due to serious illness or long-term treatment |
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| TRICARE Prime is similar in design to |
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| Annual enrollment is not necessary for |
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| TRICARE Standard allows the greatest freedom in selecting |
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| Providers may enroll in TRICARE Standard on a |
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The nonavailability statement (NAS) is a certificate issued at a treatment facility when a |
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· particular service cannot be performed at a military treatment center. |
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· 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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The program designed to provide medical treatment and other benefits for respiratory conditions related to former employment in a coal mine is the |
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Federal Black Lung Program |
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Working while impaired by an illicit drug would preclude an employee from receiving workers’ compensation benefits with an |
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The OSHA Act of 1970 was enacted by Congress to protect employees against injuries from |
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occupational hazards in the workplace |
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Obtaining and retaining MSDS (Material Safety Data Sheets) is an |
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Employees who, during the normal course of their job, may come into contact with human blood and other potentially infectious materials must be offered |
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The employer carries the burden of the cost and is responsible for paying |
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· workers’ compensation premiums |
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The employer must be contacted immediately by the treating provider to ensure |
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proper handling of all job-related injuries or conditions. |
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The provider is responsible for completing the |
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First Report of Injury form |
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The filing deadline for the First Report of Injury form |
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varies from state to state |
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The patient’s signature is not required on |
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the workers’ compensation claim |
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If the workers’ compensation carrier requests further medical information about the claim, it is the provider’s responsibility to |
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If a patient’s workers’ compensation claim is denied, the patient is allowed to file an |
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· appeal regarding the denial. |
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