Reimbursement - Test 2 with Accurate
Solutions
Describe Medicare Part A - ANSWER-Medicare Part A is for Inpatients and is provided
with no premiums to most beneficiaries
Describe Medicare Part B - ANSWER-Medicare Part B is supplemental medical
insurance, optional and covers physician services, medical services and medical
supplies not covered by Part A
Describe Medicare Part C - ANSWER-Medicare Part C is excluded from Part A and Part
B Medicare. Medicare Part C coverage, also known as Medicare Advantage is for Long-
term nursing care, Custodial care, Dental services and Vision services.
Describe Medicare Part D - ANSWER-Medicare Part D is for Drug benefit
Describe TRICARE Prime - ANSWER-TRICARE Prime - For all active-duty service
members and activated Guard or Reserve members.
Describe TRICARE Prime Remote? - ANSWER-TRICARE Prime Remote - For active-
duty that live and work in remote areas.
What is TRICARE for Life - ANSWER-TRICARE for Life - Secondary coverage for
TRICARE beneficiaries who become entitled to Medicare Part A. TRICARE becomes
the secondary payer to Medicare. Required to participate in Medicare Part B and pay
Medicare Part B premiums.
What is CHAMPVA? - ANSWER-CHAMPVA - Department of Veterans Affairs provides
covered healthcare services and supplies to eligible beneficiaries through the Civilian
Health and Medical Program of the department of Veterans Affairs. Available for the
spouse or widower and children of a veteran. Persons eligible for TRICARE benefits
cannot participate in CHAMPVA.
Describe Indian Health Services? - ANSWER-Indian Health Services - Indian Health
Service was created to uphold the federal government's obligation to promote healthy
American Indian and Alaskan native people, communities and cultures. Established in
1787 based on Article 1, Section 8 of the US. Constitution.
Describe Workers Compensation? - ANSWER-Workers Compensation - Provided to
most employees to cover healthcare costs and lost income that results from a work-
related injury or illness.
, Know the different parts of Medicare Part A and what they cover? - ANSWER-Medicare
Part A for Inpatient hospital insurance, No premiums to most beneficiaries, Most require
annual deductible and copayment to be paid by beneficiary, Services include, Inpatient
hospitalization, Long-term care hospitalization, Skilled nursing facility services, Home
health services, Hospice care
Know the different parts of Medicare Part B and what they cover? - ANSWER-Medicare
Part B is a Supplemental medical insurance. Optional insurance package that may be
purchased Covers physician services, medical services, and medical supplies not
covered in Part A. Most are provided on an outpatient basis. Responsible for annual
deductible and service copayments
Know the different parts of Medicare Part C and what they cover? - ANSWER-Medicare
Part C Beneficiaries can purchase additional coverage Managed care option knows as
Medicare Advantage. Provides Long-term nursing care, Custodial care, Dental services,
Vision services, Routine examinations, except initial preventive medicine examination
added by MMA, Health and Wellness education, Acupuncture, Hearing aids
Know the different parts of Medicare Part D and what they cover? - ANSWER-Medicare
Part D is Medicare drug benefit. Offers outpatient drug coverage provided by private
prescription drug plans and Medicare Advantage. Pay a monthly premium that varies by
plan. Low-income beneficiary provisions are built into the program for seniors who
cannot afford the standard copayment amounts. Established improved access to
pharmacies, an up-to-date formulary, and emergency access for Medicare companies.
Characteristics Managed Care Organizations - ANSWER-Purpose of managed care is
to provide affordable, high-quality healthcare. In the Balanced Budget Act of 1997 these
plans are termed coordinated care plans. Merges, clinical, financial and administrative
processes to manage access, costs, and quality of healthcare. Characteristics Providing
quality care and cost effective care Lines between quality care and cost -effective care
blur Not unique to MCO Often associated with MCO because of the characteristics
prevalence and extent of use in MCO Coordinate and control healthcare services to
improve quality and to contain expenditures
What is Disease management - ANSWER-Part of Care management tools include
coordination of care, disease management, and the application of evidence-based
clinical practice guidelines. Disease management focuses on preventing exacerbation
of chronic diseases and promoting healthier lifestyles for patients and clients with
chronic diseases Patients are monitored to promote adherence to treatment plans and
to detect early signs and symptoms of exacerbation Often focus on diabetes, congestive
heart failure, coronary heart disease, chronic obstructive pulmonary disease, and
asthma.
Solutions
Describe Medicare Part A - ANSWER-Medicare Part A is for Inpatients and is provided
with no premiums to most beneficiaries
Describe Medicare Part B - ANSWER-Medicare Part B is supplemental medical
insurance, optional and covers physician services, medical services and medical
supplies not covered by Part A
Describe Medicare Part C - ANSWER-Medicare Part C is excluded from Part A and Part
B Medicare. Medicare Part C coverage, also known as Medicare Advantage is for Long-
term nursing care, Custodial care, Dental services and Vision services.
Describe Medicare Part D - ANSWER-Medicare Part D is for Drug benefit
Describe TRICARE Prime - ANSWER-TRICARE Prime - For all active-duty service
members and activated Guard or Reserve members.
Describe TRICARE Prime Remote? - ANSWER-TRICARE Prime Remote - For active-
duty that live and work in remote areas.
What is TRICARE for Life - ANSWER-TRICARE for Life - Secondary coverage for
TRICARE beneficiaries who become entitled to Medicare Part A. TRICARE becomes
the secondary payer to Medicare. Required to participate in Medicare Part B and pay
Medicare Part B premiums.
What is CHAMPVA? - ANSWER-CHAMPVA - Department of Veterans Affairs provides
covered healthcare services and supplies to eligible beneficiaries through the Civilian
Health and Medical Program of the department of Veterans Affairs. Available for the
spouse or widower and children of a veteran. Persons eligible for TRICARE benefits
cannot participate in CHAMPVA.
Describe Indian Health Services? - ANSWER-Indian Health Services - Indian Health
Service was created to uphold the federal government's obligation to promote healthy
American Indian and Alaskan native people, communities and cultures. Established in
1787 based on Article 1, Section 8 of the US. Constitution.
Describe Workers Compensation? - ANSWER-Workers Compensation - Provided to
most employees to cover healthcare costs and lost income that results from a work-
related injury or illness.
, Know the different parts of Medicare Part A and what they cover? - ANSWER-Medicare
Part A for Inpatient hospital insurance, No premiums to most beneficiaries, Most require
annual deductible and copayment to be paid by beneficiary, Services include, Inpatient
hospitalization, Long-term care hospitalization, Skilled nursing facility services, Home
health services, Hospice care
Know the different parts of Medicare Part B and what they cover? - ANSWER-Medicare
Part B is a Supplemental medical insurance. Optional insurance package that may be
purchased Covers physician services, medical services, and medical supplies not
covered in Part A. Most are provided on an outpatient basis. Responsible for annual
deductible and service copayments
Know the different parts of Medicare Part C and what they cover? - ANSWER-Medicare
Part C Beneficiaries can purchase additional coverage Managed care option knows as
Medicare Advantage. Provides Long-term nursing care, Custodial care, Dental services,
Vision services, Routine examinations, except initial preventive medicine examination
added by MMA, Health and Wellness education, Acupuncture, Hearing aids
Know the different parts of Medicare Part D and what they cover? - ANSWER-Medicare
Part D is Medicare drug benefit. Offers outpatient drug coverage provided by private
prescription drug plans and Medicare Advantage. Pay a monthly premium that varies by
plan. Low-income beneficiary provisions are built into the program for seniors who
cannot afford the standard copayment amounts. Established improved access to
pharmacies, an up-to-date formulary, and emergency access for Medicare companies.
Characteristics Managed Care Organizations - ANSWER-Purpose of managed care is
to provide affordable, high-quality healthcare. In the Balanced Budget Act of 1997 these
plans are termed coordinated care plans. Merges, clinical, financial and administrative
processes to manage access, costs, and quality of healthcare. Characteristics Providing
quality care and cost effective care Lines between quality care and cost -effective care
blur Not unique to MCO Often associated with MCO because of the characteristics
prevalence and extent of use in MCO Coordinate and control healthcare services to
improve quality and to contain expenditures
What is Disease management - ANSWER-Part of Care management tools include
coordination of care, disease management, and the application of evidence-based
clinical practice guidelines. Disease management focuses on preventing exacerbation
of chronic diseases and promoting healthier lifestyles for patients and clients with
chronic diseases Patients are monitored to promote adherence to treatment plans and
to detect early signs and symptoms of exacerbation Often focus on diabetes, congestive
heart failure, coronary heart disease, chronic obstructive pulmonary disease, and
asthma.
