2004 Medicare Explained

Front Cover
CCH Incorporated, Mar 1, 2004 - Health insurance - 265 pages
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Contents

Chapter Detailed Table of Contents
13
Medicare Part AHospital Insurance
15
Social Security Retirement and Railroad Retirement Beneficiaries
16
Voluntary Enrollment in the Hospital Insurance Program
17
Disability Beneficiaries
19
EndStage Renal Disease Beneficiaries If 206 Government Employees
20
Geographical Limits
21
Coverage in General
22
Benefits and Beneficiary Protections
144
f 403 Quality Assurance
145
Relationships with Providers
147
Payments to M+C Organizations
148
Premiums and Cost Sharing
152
ProviderSponsored Organizations
156
Contracts with Medicarechoice Organizations U 409 Beneficiary Grievances Appeals and Notifications
160
Medicare Contract Determinations and Appeals
163

Accommodations
24
Personal Comfort Items
25
Drugs and Biologicals
26
Supplies Appliances and Equipment If 214 Diagnostic and Therapeutic Items and Services
27
Services of Interns ResidentsinTraining and Teaching Physicians
29
Nursing and Related Services PrivateDuty Exclusion If 218 Inpatient Services Connected with Dental Services
30
Limitations on Coverage If 221 Inpatient Hospital Deductible U 222 Inpatient Hospital Coinsurance
31
U223 Whole Blood and Packed Red Blood Cells
32
Duration of Covered Inpatient Hospital Services
33
Psychiatric Hospital Restrictions
37
Physicians Professional Services II 227 Emergency Services
38
Religious Nonmedical Health Care Institutions
40
Hospital DefinedQualified Hospitals
41
Nursing Home Services
42
Coverage of PostHospital Nursing Home Care
43
If231 Accommodations If 232 Rights of SNF Residents
44
Physical Occupational and Speech Therapy If 234 Medical Social Services If 235 Drugs and Biologicals
46
Supplies Appliances and Equipment If 237 Interns and ResidentsinTraining If 238 Whole Blood and Packed Red Blood Cells If 239 Other Services
47
Limitations on Coverage
48
Skilled Nursing Facility DefinedQualified Facilities
53
Qualifying Conditions for Coverage If 251 Skilled Nursing Care
55
Physical and Occupational Therapy and SpeechLanguage Pathology Services
57
Medical Social Services
58
Home Health Aides U 255 Medical Supplies and Durable Medical Equipment
59
Interns and ResidentsinTraining U 257 Outpatient Services If 260 Care of a Physician U262 Establishment of a Plan of Care
60
Patient Confined to Home If 266 Visits
61
Specific Exclusions from Coverage 1f268 Home Health Agency DefinedQualified Home Health Agencies
66
Hospice Care U270 Hospice Care
69
Medicare Part BSupplemental Insurance
75
Enrollment Periods If 312 Automatic Enrollment If 313 Coverage Period If 320 Premiums Benefits
76
In General
82
Deductible and Coinsurance
83
Physicians Services
85
Medical and Other Health Services
88
Services and Supplies Furnished Incident to Physicians Services
90
Outpatient Hospital Services
94
Diagnostic XRay Laboratory and Other Diagnostic Tests
96
XRay Radium and Radioactive Isotope Therapy If 355 Ambulance Services
99
Durable Medical Equipment If 357 Prosthetic Devices
103
Braces Artificial Limbs Etc U 359 Surgical Dressings Splints Casts Etc U 361 Inpatient Ancillary Services
114
Listed Drugs and Biologicals
116
Other Healthcare Practitioners
121
Prevention Services
123
U370 Therapeutic Shoes
126
Physical Occupational and Speech Therapy Services
127
Rural Health Clinics and Federally Qualified Health Centers
130
Home Health Services
131
Comprehensive Outpatient Rehabilitation Facility Services
132
Ambulatory Surgical Services
133
U387 Mental Health Services
135
U388 Telehealth Services
136
Medicare Part CManaged Care
139
Eligibility Election and Enrollment
141
Demonstration Programs
164
Medicare Part DPrescription Drug Benefit
167
Eligibility and Enrollment
170
Prescription Drug Coverage Defined
171
Standard and Alternate Prescription Drug Coverage Requirements U 520 Annual OutofPocket Threshold
172
U525 Beneficiary Protections
173
Full Risk Plans Limited Risk Plans and Fallback Plans U 535 Premiums Late Enrollment Penalty
174
Premium and CostSharing Subsidies for LowIncome Individuals
176
Subsidies for Part D Eligible Individuals for Qualified Prescription Drug Coverage
178
Special Rules for EmployerSponsored Programs
179
Exclusions from Coverage
181
No Legal Obligation to
183
Services Paid for by Governmental Entity
184
Services Outside the United States U613 War Claims
186
Routine Checkups Glasses Eye Examinations Immunizations
187
Foot Care and Orthopedic Shoes If 625 Custodial Care
188
Cosmetic Surgery If 630 Routine Costs in Clinical Trials
189
Charges by Relatives
190
Dental Services If 635 Services Not Provided InHouse
191
Alternate Insurance Coverage If 637 Workers Compensation
192
Automobile and Liability Insurance Coverage
196
Employer Group Health Plans
197
Limitation on Payments for Certain Drugs If 646 Individuals and Entities Guilty of Program Abuses
199
Surgery Assistants in Cataract Operations
200
Administrative Provisions
201
Role of the State and Local Agencies
203
Role of the Fiscal Intermediaries Carriers and Medicare Administrative Contractors If 707 Role of Medicaid If 710 Quality Improvement Organizatio...
206
U715 Privacy of Health Data
209
Fraud and Abuse Penalties
212
Provider Participation Agreements
221
Medigap Insurance
226
Payment Rules
229
Actual Charge Restrictions
236
Nonphysician Practitioners If 827 Clinical Diagnostic Laboratory Tests
240
Assignment
243
Participation Program for Physicians and Suppliers
245
Private NonMedicare Contracts with Healthcare Practitioners
246
If835 Home Health Agencies
247
Hospital Outpatient Services
249
U839 Skilled Nursing Facilities
258
Rehabilitation Hospitals
261
LongTerm Care Hospitals
263
Psychiatric Hospitals and Units
266
EndStage Renal Disease
267
Claims Payments and Appeals
273
Part A Benefit Claims U 903 Part B Benefit Claims
275
Overpayments and Underpayments
276
If908 Waiver of Liability
278
Beneficiary Appeals
281
U930 Provider Appeals
285
Topical Index
287
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