PTCB BILLING & REIMBURSEMENT CERTIFICATE
VOCABULARY STUDY GUIDE WITH COMPLETE SOLUTION!!
NCPDP
Answers :National Council for prescription drug programs - leads transformation
in the pharmacy services sector by creating and promoting standards for electronic
healthcare transactions
HMO
Answers :Health Maintenance Organization - insurance plans with typically lower
monthly premiums where all health care services go through one primary
investigation and out-of-network services are not typically covered
PPO
Answers :Preferred Provider Organization - insurance plans that offer more
flexibility in covering the costs of out-of-network providers where a primary
physician is not required
CMS
Answers :Centers for Medicare and Medicaid Services - a Department of Health
and Human Services that provides health coverage such as Children's Health
Insurance Program (CHIP) and Health Insurance Marketplace
Medicare Eligibility Requirements
Answers :age 65 or older, people with disabilities and people with end stage renal
disease
Medicaid
Answers :a state funded program for low-income families and children, pregnant
women, elderly and people with disabilities which may include dental services
, Tricare Eligibility
Answers :uniformed service members and their families, national guard/reserve
members and their families, survivors, former spouses and Medal of Honor
recipients and their families
Medicare Part A Coverage
Answers :covers inpatient care in hospitals, critical access hospitals, skilled
nursing facilities, hospice care; can be purchased if Medicare taxes were never
paid, estimated $252-$458 a month depending on how many quarters Medicare tax
was paid
Premium Free Eligibility for Medicare Part A
Answers :65 or older and taxes were paid into Medicare for at least 10 years by
yourself or spouse, receiving or eligible to receive Retirement Benefits from Social
Security or Railroad Retirement, have Medicare covered government employment,
under the age of 65 and eligible for disability benefits or a kidney
dialysis/transplant patient
Medicare Part B Coverage
Answers :covers services or supplies that are needed to treat a medical condition
(i.e. test strips for diabetes) and preventative care (i.e. vaccines) which costs about
$145 a month
Medicare Part C (Medicare Advantage)
Answers :all in one alternative offered by private companies with typically lower
out-of-pocket costs but providers must be in plan's network however there may be
additional benefits included such as vision, dental, etc.
Medicare Part D Coverage
VOCABULARY STUDY GUIDE WITH COMPLETE SOLUTION!!
NCPDP
Answers :National Council for prescription drug programs - leads transformation
in the pharmacy services sector by creating and promoting standards for electronic
healthcare transactions
HMO
Answers :Health Maintenance Organization - insurance plans with typically lower
monthly premiums where all health care services go through one primary
investigation and out-of-network services are not typically covered
PPO
Answers :Preferred Provider Organization - insurance plans that offer more
flexibility in covering the costs of out-of-network providers where a primary
physician is not required
CMS
Answers :Centers for Medicare and Medicaid Services - a Department of Health
and Human Services that provides health coverage such as Children's Health
Insurance Program (CHIP) and Health Insurance Marketplace
Medicare Eligibility Requirements
Answers :age 65 or older, people with disabilities and people with end stage renal
disease
Medicaid
Answers :a state funded program for low-income families and children, pregnant
women, elderly and people with disabilities which may include dental services
, Tricare Eligibility
Answers :uniformed service members and their families, national guard/reserve
members and their families, survivors, former spouses and Medal of Honor
recipients and their families
Medicare Part A Coverage
Answers :covers inpatient care in hospitals, critical access hospitals, skilled
nursing facilities, hospice care; can be purchased if Medicare taxes were never
paid, estimated $252-$458 a month depending on how many quarters Medicare tax
was paid
Premium Free Eligibility for Medicare Part A
Answers :65 or older and taxes were paid into Medicare for at least 10 years by
yourself or spouse, receiving or eligible to receive Retirement Benefits from Social
Security or Railroad Retirement, have Medicare covered government employment,
under the age of 65 and eligible for disability benefits or a kidney
dialysis/transplant patient
Medicare Part B Coverage
Answers :covers services or supplies that are needed to treat a medical condition
(i.e. test strips for diabetes) and preventative care (i.e. vaccines) which costs about
$145 a month
Medicare Part C (Medicare Advantage)
Answers :all in one alternative offered by private companies with typically lower
out-of-pocket costs but providers must be in plan's network however there may be
additional benefits included such as vision, dental, etc.
Medicare Part D Coverage
