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Exam 4: Government Payer Types

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Question 1

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The federal/state entitlement program that came out of the Title XIX of the Social Security Act that pays for medical assistance for individuals with low income is called Medicaid, which became law in 1965 and is funded only by the individual state governments.

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Question 2

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Mandatory Medicaid services include inpatient hospital services, outpatient hospital services, pregnancy-related services, lab and X-ray, pediatric and nurse practitioner services, and nurse-midwife services.

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Question 3

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According to CMS, in order for a patient to be eligible for home health services under Medicare Parts A and B, the physician needs to attest that the patient requires home care and is homebound.

According to CMS, the timing and content for certification are for the first 90 days of hospice coverage. The hospice must obtain, no earlier than _____ days prior to care and no later than _____ calendar days after hospice is initiated, oral or written certification of the terminal illness by the medical director of the hospice or the physician member of the hospice organization.

The age requirement for the HI portion of Medicare Part A is 65 years of age or older. Persons can apply for the HI benefit when they are at least 6 months away from their 65th birthday.

People with Amyotrophic Lateral Sclerosis (ALS) were given eligibility for Medicare, without having to wait for the customary 24-month waiting period.

A hospice patient is discharged if the person:

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive healthcare program where the Veterans Affairs (VA) shares the cost of care for covered services and supplies.

Under Medicare Part A, dialysis supplies for in-home dialysis are covered along with drug clotting factors for hemophilia patients and prescription drugs for immunosuppressive therapy for individuals who receive an organ transplant.

The term _________________ is used by a beneficiary to cover healthcare services that are not covered by Part A or B. These policies must meet federally imposed standards and are offered by Blue Cross and Blue Shield and various other commercial health insurance companies.

Under Medicare Part A, all of the following are covered items in an inpatient hospital, except:

_____________________ is also known as Medicare Advantage. It is an alternative to the traditional Medicare plan for beneficiaries to choose from, instead of Medicare Part A or B.

A benefit period is a time frame that is part of a hospital stay until the patient is discharged. The time after the discharge and the next admission needs to be at least _________ consecutive days since the last stay in a hospital or skilled nursing facility.

An inpatient stay is defined by CMS as a person who has been admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services.

According to CMS, ESRD occurs from the destruction of normal kidney tissues over a long period of time. Often, there are no symptoms until the kidney has lost more than _____________ of its function and is usually irreversible and permanent.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (also known as Welfare Reform) brought about many changes, which included the implementation of:

There are several different types of payment adjustments in the Home Health Prospective Payment System, such as _______________________, which entails four or fewer visits paid by discipline.

Medicare Part B is financed by monthly premiums from those beneficiaries who voluntarily enroll in the program. The funds generated by the collection of premiums are deposited in a separate account known as the Federal Supplementary Medical Trust Fund.

Hospice is generally provided for a beneficiary in their home.

If while on hospice a Medicare beneficiary is in need of or requires care or hospitalization for treatment that is not related to hospice service, Medicare will not pay for this treatment.