Chapter 12 – Insurance Multiple Choice – Flashcards
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medicare part A is run by
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the centers for medicare and Medicaid services
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medicare is a
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federal health insurance program
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letter "D" following the identification number on the patients medicare card indicates a
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widow
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the letters preceding the number on the patients medicare identification card indicate
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railroad retiree
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part A of medicare covers
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hospice care
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part B of medicare covers
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diagnostic test
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medicare part A benefit period ends when a patient
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has not been a bed patient in any hospital or nursing facility for 60 consecutive days.
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the part B medicare annual deductible is
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$135
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medicare provides a one-time baseline mammographic examination for women ages 35 to 399 and preventive mammogram screenings for women 40 years or older
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once a year
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the frequency of Pap tests that may be billed for a medicare patient who is low risk is
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once every 24 months
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medigap insurance may cover
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80% of the medicare allowed amount
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when a medicare beneficiary has employer supplemental coverage, medicare refers to these plan as
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MSP
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some senior HMOs may provide services not covered by medicare, such as
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eyeglasses and prescription drugs
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a state-based group of doctors working under government guidelines reviewing cases for hospital admission and discharge is known as a
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QIO
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a participating physician with the medicare plan agrees to accept
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80% of the medicare-approved charge
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in the medicare program, there is mandatory assignment for
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surgery performed in the physician office
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a medicare prepayment screen
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identifies claims to review for medical necessity
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when a medicare patient signs an advance beneficiary notice, the procedure code for the service provided must be modified using the HCPCS level 2 modifier
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-GA
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under the prospective payment system (PPS), hospitals treating medicare patients are reimbursed according to
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pre-established rates for each type of illness treated based on diagnosis
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payments to hospitals for medicare services are classified according to
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DRGs
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the 1987 omnibus budget reconciliation act (OBRA) established the
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MAAC
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the HCPCS national alphanumeric codes are referred to as
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level 2 codes
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organizations handling claims from hospitals, nursing facilities intermediate care facilities long-term care facilities and home health agencies are called
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fiscal intermediaries
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the time limit for submitting a medicare claim is
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the end of the calendar year following the fiscal year in which services were performed
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when a meicare carrier transmits a medigap claim electronically to the medigap carrier, it is referred to as a
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crossover claim
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an explanation of benefits document for a patient under the medicare program is referred to as the
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medicare remittance advice documenet
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a claims assistance professional (CAP)
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may act on the medicare beneficiarys behalf as a client representative.
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when a remittance advice (RA) is received from mediare, the insurance billing specialist should
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post each patients name and the amount of payment on the day sheet and the patients ledger card
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if a check is received from medicare and it is obvious that is an overpayment the insurance billing specialist should
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deposit the check and then write to medicare to notify them of the overpayment
