IHMO MULTIPLE CHOICE CH 12 – 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 ___ health insurance program
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federal
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The 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 retirees
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Part A od medicare covers
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hospice care
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Part B of medicare covers
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diagnostic tests
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The 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 days
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Currently the Part B Medicare Annual deductible is
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$147
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Medicare provides a one-time baseline mammographic examination for women ages 35 to 39 and preventive mammogram screening for women 40 years or older ____.
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once a year
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The frequency of Pap tests 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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the deductible not covered under Medicare
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When a Medicare beneficiary has employer supplemental coverage, Medicare refers to these plans 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 program that contract with CMS to review medical necessity and appropriateness of inpatient medical care is known as
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QIO
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A participating physician with the Medicare plan agrees to accept 80% of the
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medicare-approved charge
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in the Medicare program, there is mandatory assignment for
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clinical laboratory tests
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A Medicare prepayment screen
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both a and b, identifies claims to review for medical necessity, monitors the number of times given procedures can be billed during a specific time frame
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When a Medicare patient signs an advance beneficiary notice of non coverage, the procedure code for the service provided must be modified using which HCPCS level II 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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The HCPCS national alphanumeric codes are referred to as Level _____ codes.
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II
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Payment 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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Organizations handling claims fro hospitals, nursing facilities, and home health agencies are called
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fiscal intermediaries
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The time for submitting a Medicare claim is
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within 12 months from the date of service
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When a Medicare carrier transmits a Mediap claim electronically to the Medifap carrier, it is referred to as an ____ claim
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crossover
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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 document
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When a remittance advice (RA) is received from Medcare, 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 it is an overpayment, the insurance billing specialist should
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deposit the check and then write to Medicare to acknowledge the overpayment
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A claim assistant professional (CAP)
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may act on the Medicare beneficiary's behalf as a client representative
