Question

please define :

1. Center for Medicare and Medical Services

2. Crossover Claims

3. Formulary

4. Hospice

5. Medicare Administrative Contractor

6. MEDICARE PART A

7. MEDICARE PART B

8. MEDICARE PART C

9. MEDICARE PART D

10. MEDIGAP

11. ASSIGNMENT

12. CORRECT CODING INITIATIVE

13.MEDICAL NECESSITY

ABBREVIATIONS:

1. COBRA

2. DME

3. MEDI-MEDI

medical billing

Answer 1

1) Centre for Medicare and Medicaid services

  The centre for Medicare and Medicaid services (CMS) which was previously know as Health care Financing Administration

It is a federal agency which administer the nations Medicare program and it will also work with the state government to administer programmes that include Medicaid and Children Health Insurance program.

2) Crossover claims

A crossover claim is a type of claim for a recepient who are eligible for both the Medicare and Medi-cal ,in which the claim billed to the Medi-cal for the Medicare deductible and coinsurance .

( Crossover type of claim are approved or paid by the Medicare ) .

3) Formulary

Formulary can be simply defined as the collection of formulas , recepies ,or prescription

In medicine ; Formulary is defined as the list of a prescription drugs which are covered under a specific healthcare plan .

( Effective use of formulary helps to reduce the overall medical cost and thus improve patient access to more affordable care and help to improve quality of life )

4) Hospice

An hospice is a home or a special place to provide care for the sick or terminally ill inorder to improve the comfort and quality rather than focusing on cure .

(Example : hospital's for people who are dying especially from cancer or organization which provide care for peoples who are dying .)

5) Medicare administrative contractor

Medicare Administrative contractor or ( MAC ) is a private health care insurer who has been awarded for the authority to process Medicare part A and part B medical claims and claims for durable medical equipment for Medicare free - for service beneficiaries.

MAC responsibilities include ;

* Process free for beneficiaries claims ( example ; for hospital ,providers ,hospice etc)

* Review the medical records of the selected claims

* Establish local coverage determinations

* Handle the providers reimbursement services

6) Medicare part A

Medicare part A is the one which covers the hospital expenses such as hospital stay ,skilled nursing care ,hospice care and limited home health care .

7) Medicare part B

Medicare part B is the one which covers the medical expenses such as medical services and supplies which are medically necessary for the treatment .

It covers doctor's visits ,x-rays ,blood works ,out patient care and other preventive services .