question

Medicare provides insurance for disabled individuals if they have received social security disability benefits for 24 months.

answer

True

question

All persons age 65 who meet eligibility requirements for medicare receive Medicare Part B (outpatient coverage).

answer

False

question

Medicare provides insurance for disabled workers of any age.

answer

True

question

Patients who elect Medicare Part B coverage pay annually increasing basic premium payments.

answer

True

question

It is possible for an alien to be eligible for Medicare Part A and Part B

answer

True

question

Employee and employer contributions help pay for Medicare Part A health services.

answer

True

question

Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility.

answer

False

question

The number of Medicare hospital benefit periods a patient can have for hospital care is limited.

answer

False

question

Medicare Part A is called supplementary medical insurance (SMI)

answer

False

question

Funds for Medicare Part B come equally from those who sign up for it and the federal government.

answer

True

question

Medicare covers some services by chiropractors.

answer

True

question

In the Medicare program, a physical examination is a covered benefit when performed within 12 months of enrollment.

answer

False

question

Benefits of MediGap policies may vary from one state to another

answer

False

question

A Medicare patient with an HMO does not need a supplemental insurance policy.

answer

True

question

When a Medicare recipient chooses a Medicare senior plan, he or she forfeits the Medicare card

answer

False

question

Once a patient changes from Medicare to a senior HMO, the patient must stay with that HMO for the remainder of the calender year.

answer

False

question

Nonparticipating physicians have an option regarding accepting assignment on the Medicare patient

answer

True

question

A nonparticipating physician who is not accepting assignment may bill any fee he or she wishes.

answer

False

question

Because Medicare is a federal program providing uniform benefits, payment of each medical service rendered to Medicare patients is consistent across the united states.

answer

False

question

Medicare Part B insurance payments are all handled by the National Blue Cross Association.

answer

False

question

When a CMS-1500 claim form is automatically transferred by Medicare to a MediGap carrier, there is no need to obtain a separate signature authorization for the MediGap carrier.

answer

False

question

the patient`s authorized signature is not required on the CMS-1500 claim form for Medicare-Medicaid cases

answer

True

question

The time limit for sending in Medicare claims is the end of the calender year in which professional services were performed

answer

False

question

The assignment on patient with Medicare-Medicaid must always be accepted or Medicaid will not pick up the residual.

answer

True

question

Medicare transmits MediGap claims electronically for participating physicians when MediGap information is provided on the original Medicare claim.

answer

True

question

MediGap payments go directly to the beneficiary.

answer

False

question

Medicare`s Remittance Advice document was formerly known as the Explanation of Medicare Benefits

answer

True

question

Medicare Part A is run by

answer

The Centers for Medicare and Medicaid Services

question

Medicare is a

answer

federal health insurance program

question

The letter "D" following the identification number on the patient`s Medicare card indicates a

answer

Widow

question

The letters preceding the number on the patient`s Medicare identification card indicate

answer

Railroad retiree.

question

Part A of Medicare covers

answer

Hospice care

question

Part B of Medicare covers

answer

diagnostic tests

question

Medicare Part A benefit period ends when a patient

answer

has not been a bed patient in any hospital or nursing facility for 60 consecutive days

question

The Part B Medicare annual deductible is

answer

$135

question

Medicare provides a tone time baseline mammographic examination for women ages 35 to 39 and preventive mammogram screenings for women 40 years or older

answer

Once a year

question

The frequency of Pap tests that may be billed for a mMedicare patient who is low risk is

answer

Once every 24 months

question

Medigap insurance may cover

answer

the deductible not covered under Medicare

question

When a medicare beneficiary has employer supplemental coverage, Medicare refers to these plans as

answer

MSP

question

Some senior HMOs may provide services not covered by Medicare,such as

answer

eyeglasses and prescription drugs

question

A state based group of doctors working under government guidelines reviewing cases for hospital admission and discharge is known as a:

answer

QIO

question

A participating physician with the medicare plan agrees to accept

answer

80% of the Medicare-approved charge

question

In the Medicare program, there is mandatory assignment for

answer

Clinical laboratory tests

question

A medicare prepayment screen

answer

Both A and B.. Identifies claims to review for medical necessity and Monitors the number of times given procedures can be billed during a specific time frame.

question

When a medicare patient signs an advance beneficiary notice, the procedure code for the service provided must be modified using the HCPCS Level II modifier

answer

-GA

question

Under the prospective payment system (PPS), hospitals treating Medicare patients are reimbursed according to

answer

Preestablished rates for each type of illness treated based on diagnosis

question

Payments to hospitals for Medicare services are classified according to

answer

DRGs

question

The 1987 Omnibus Budget Reconciliation Act (OBRA) established the

answer

MAAC

question

The HCPCS National alphanumeric codes are referred to as

answer

Level II codes

question

Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long term care facilities and home health agencies are called

answer

fiscal intermediaries

question

The time limit for submitting a Medicare claim is

answer

the end of the calender year following the fiscal year in which services were performed

question

When a Medicare carrier transmits a Medigap claim electronically to the Medigap carrier, it is referred to as a/an

answer

crossover claim

question

An explanation of benefits document for a patient under the Medicare program is referred to as the

answer

Medicare remittance advice document

question

A claims assistance professional (CAP)

answer

may act on the Medicare beneficiary's behalf as a client representative

question

When a remittance advice (RA) is received from Medicare, the insurance billing specialist should

answer

post each patient's name and the amount of payment on the day sheet and the patient's ledger card

question

If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist should

answer

deposit the check and then write to Medicare to notify them of the overpayment

question

Medicare provides insurance for people _____________ years of age or older who are retired on social security

answer

65

question

Medicare outpatient coverage is referred to as part _________

answer

B

question

The alpha letter _________following the identifcation number on a female patient's Medicare card indicates that is is her husband's number

answer

B

question

A specialized insurance policy that is predefined by the federal government for the Medicare beneficiary to cover the deductible and copayment amounts is referred to as _________

answer

Medi gap

question

The Civil Monetary Penalties Law carries a sanction for a penalty of up to ______________ for each item or service wrongfully listed in a payment request to Medicare or Medicaid

answer

2500

question

A Medicare nonparticipating physician may bill no more than the Medicare ___________

answer

limiting charge

question

For all elective surgeries for which the actual charge will be ______________ or more, a Medicare nonparticipating physician who does not accept assignment must provide the beneficiary in writing with the estimated fee for any elective surgery, the estimated Medicare-approved allowance for the surgery, and the cost difference between the approved allowance and the Medicare limiting charge

answer

500

question

The Medicare HCPCS coding system has __________ levels

answer

2

question

Organizations handling claims from physicians and other suppliers of services covered under Medicare Part B are called fiscal intermediaries or _________

answer

MAC

question

When a Medicare patient's payment authorization is on file, the abbreviation ___________ may be used on the CMS-1500 claim form

answer

SOF

question

An NPI number issued to a provider by CMS is the acronym for ___________-

answer

National I

question

A patient classifed with ESRD may be provided benefits from Medicare. What does ESRD stand for?

answer

End Stage Renal Disease

question

What does TEFRA stand for?

answer

Tax equity Fiscal Responsibility Act

question

What type of coverage does a Medi-Medi patient have?

answer

Medicare, Medicaid

question

On what basis are HMO enrollees classifed into DCGs

answer

on the basics of each beneficiary prior to 12 month history of hospitalization

question

When Medicare payments are posted to a seperate day sheet, what should the day sheet payment total agree with?

answer

Deposit slip total

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