Health Insurance Today Chap 9 -next Step Chap 3

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7. An individual cannot qualify for both medicare and medicaid

True

False

8. Part ____ of medicare helps pay for perscription drugs

A

B

C

D

9. The 6-month period during which and individual can sign up for the medicare program is called the open enrollment period

True

False

10. A "small provider" is one with fewer that 25 full time employees

True

False

11. Part _____ of medicare includes the new medicare advantage options

A

B

C

D

12. Local medical review policies (LMRPs) outline general provisions for acceptance or rejection of medicare claims

True

False

13. Part ________ of medicare helps pay for physician and outpatient charges

A

B

C

D

14. Coverage with medicare part c (medicare advantage plans) typically includes both part a and part b expenses

True

False

15. A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is

Medicaid

Medicare

Medigap

Managed care

16. The are _____________ parts to the medicare program

Two

Three

Four

Five

17. Under medicare part d, individual prescription drug plans must offer no less than the basic medicare coverage

True

False

18. A medicare beneficiary can sign a special release of information that is good for his/her lifetime

True

False

19. All medicare advantage plans offer the exact same coverages as original medicare

True

False

20. Medicare managed care plans fill the "gaps" in basic medicare similar to medigap policies

True

False

21. After beneficiaries (who are enrolled in original medicare) satisfy the yearly deductible, they pay a 20% copayment of all "allowable" charges

True

False

22. Medicare now pays for certain screening procedures in their "welcome to medicare" program

True

False

23. Medicare payments can be automatically deposited into a providers designated bank account using

Money orders

Cashiers checks

Certified deposits

Electronic funds transfers

24. A claim for which a beneficiary elects to assign benefits under a medigap policy is called a "mandated medigap transfer"

True

False

25. Postpayment medicare audits are often triggered by statistical irregularities

True

False

26. The duration of time during which a medicare beneficiary is eligible for part a benefits for inpatient hospital or skilled nursing facility charges is called a/an

Time period

Limiting phase

Benefit period

Episode of care

27. Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an

Secondary claim

Grievance

Appeal

ABN

28. Local coverage decisions (LCDs) focus exclusively on whether a service is reasonable and necessary according to the ICD-9 code that corresponds with the CPT code

True

False

29. Medicare part d covers long-term (nursing home) care

True

False

30. Individuals pay for medicare part b coverage through

Wage deductions

Monthly premiums

Personal checks

Electronic funds transfers

31. Fees that medicare permits for a particular procedure, service, or supply are called

UR fees

Cap limits

Restrictive fees

Allowable fees

32. Part ________ of medicare helps pay for charges incurred during an inpatient hospital stay

A

B

C

D

33. The term used when medicare is not responsible for paying first because of coverage under another insurance policy is

Medigap

Medi-medi

Supplemental payer

Medicare secondary payer (MSP)

34. There are ______ levels to the medicare appeals process

Three

Five

Seven

Ten

35. Medicare is always the "payer of last resort"

True

False

36. Beneficiaries enrolled in the "original" medicare plan must pay a yearly deductible

True

False

37. Only medicare beneficiaries can file an appeal

True

False

38. An individual who has health insurance coverage through both the medicare and medicaid programs is commonly referred to as a

Client

Customer

Beneficiary

Member

39. In order to qualify for medicare coverage, durable medical equipment (DME) must be ordered by a physician for use in the home and must be reusable

True

False

40. The act that provides for a federal system of old age, survivors, disability, and hospital insurance is the

Federal insurance contribution act (FICA)

Health insurance portability and accountability act (HIPPA)

Emergency medical treatment and active labor act (EMTLA)

Consolidated omnibus budget reconciliation act (COBRA)

41. Studies performed to improve the processes and outcomes of patient care are called

Appeals

Peer reviews

Redeterminations

Quality review studies

42. There are 20 standard medigap policies

True

False

43. Medicare part a helps pay for all of the following except

Office visits

Home healthcare

Hospice

Blood

44. The medicare beneficiarys health insurance claim number (HICN) is in the format of nine numeric characters preceded by two alpha characters

True

False

45. The first level of a medicare appeal is a telephone review

True

False

46. When a service or procedure meets medicares criteria for coverage, it is said to be

Eligible

Qualifying

Medically necessary

An entitlement

47. Medicare nonPARs do not have to submit claims for medicare patients

True

False

48. The "limiting charge" for nonPARs is 15% lower than that allowed for a PAR provider

True

False

49. For a medicare "simple" claim, blocks 9* through 9d are not to be reported

True

False

50. The letter "A" following a beneficiary's social security number on the HICN indicates the individual was a wage earner

True

False

51. The HMO is the most expensive and least restrictive type of medicare managed care plan

True

False

52. A private organization that administers part b claims is called a peer review organization

True

False

53. The act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness is

CLIA

LMRP

EMTLA

COBRA

54. ASCA requires that all initial medicare claims be filed electronically without exception

True

False

55. When it is likely the medicare will not pay for a service or procedure, that patient should be asked to sign a/an

ABN

Cms-1500

Release of information

Assignment of benefits

56. A private organization that contracts with medicare to pay part a and some of part b bills is referred to as a

Beneficiary

Third party

Financial mediator

Fiscal intermediary

57. Insurance coverage that is typically primary to medicare includes all of the following except

Medicaid

Group health plans

Workers compensation

Automobile liability insurance

58. Medicares fee schedule is based on a system whereby each payment value is found within a range of payments known as

OOPS

RBRVS

Fee for service

Usual, customary, and reasonable

59. Medicare part d began in

1965

1996

2002

2006

60. When a medicare claim is filed, the beneficiary receives a document explaining the claim adjudication called a/an

SPRA

MSN

ABN

EOB

61. The dealine for filing medicare claims is 1 year after the last date of service

True

False

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Health Insurance Today Chap 9 -next Step Chap 3

1. Managed care choices under medicare part c include_____,______,_________,_________

2.

What first name or nickname would you like us to use?

2. One of the cost-sharing requirements of medicare part b is an annual deductible of $_________, after which medicare pays _______% of _________________

3. The length of time medicare uses for hospital and skilled nursing facility (SNF) services is called a __________________.

4. For medicare part a, a benefit period begins the day an individual is _______________ to a hospital of SNF and ends when the beneficiary has not received care in a hospital or SNF for ___________ days in a row.

5. Medicare part C was previously called _________________; it was renamed by the medicare prescription, improvement, and modernization act of 2003 (MMA) and is now called

6. In january of 1999, the balanced budget act (BBA) of 1997 went into effect expanding the role of private plans to include _____________________.

7. An individual cannot qualify for both medicare and medicaid

8. Part ____ of medicare helps pay for perscription drugs

9. The 6-month period during which and individual can sign up for the medicare program is called the open enrollment period

10. A "small provider" is one with fewer that 25 full time employees

11. Part _____ of medicare includes the new medicare advantage options

12. Local medical review policies (LMRPs) outline general provisions for acceptance or rejection of medicare claims

13. Part ________ of medicare helps pay for physician and outpatient charges

14. Coverage with medicare part c (medicare advantage plans) typically includes both part a and part b expenses

15. A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is

16. The are _____________ parts to the medicare program

17. Under medicare part d, individual prescription drug plans must offer no less than the basic medicare coverage

18. A medicare beneficiary can sign a special release of information that is good for his/her lifetime

19. All medicare advantage plans offer the exact same coverages as original medicare

20. Medicare managed care plans fill the "gaps" in basic medicare similar to medigap policies

21. After beneficiaries (who are enrolled in original medicare) satisfy the yearly deductible, they pay a 20% copayment of all "allowable" charges

22. Medicare now pays for certain screening procedures in their "welcome to medicare" program

23. Medicare payments can be automatically deposited into a providers designated bank account using

24. A claim for which a beneficiary elects to assign benefits under a medigap policy is called a "mandated medigap transfer"

25. Postpayment medicare audits are often triggered by statistical irregularities

26. The duration of time during which a medicare beneficiary is eligible for part a benefits for inpatient hospital or skilled nursing facility charges is called a/an

27. Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an

28. Local coverage decisions (LCDs) focus exclusively on whether a service is reasonable and necessary according to the ICD-9 code that corresponds with the CPT code

29. Medicare part d covers long-term (nursing home) care

30. Individuals pay for medicare part b coverage through

31. Fees that medicare permits for a particular procedure, service, or supply are called

32. Part ________ of medicare helps pay for charges incurred during an inpatient hospital stay

33. The term used when medicare is not responsible for paying first because of coverage under another insurance policy is

34. There are ______ levels to the medicare appeals process

35. Medicare is always the "payer of last resort"

36. Beneficiaries enrolled in the "original" medicare plan must pay a yearly deductible

37. Only medicare beneficiaries can file an appeal

38. An individual who has health insurance coverage through both the medicare and medicaid programs is commonly referred to as a

39. In order to qualify for medicare coverage, durable medical equipment (DME) must be ordered by a physician for use in the home and must be reusable

40. The act that provides for a federal system of old age, survivors, disability, and hospital insurance is the

41. Studies performed to improve the processes and outcomes of patient care are called

42. There are 20 standard medigap policies

43. Medicare part a helps pay for all of the following except

44. The medicare beneficiarys health insurance claim number (HICN) is in the format of nine numeric characters preceded by two alpha characters

45. The first level of a medicare appeal is a telephone review

46. When a service or procedure meets medicares criteria for coverage, it is said to be

47. Medicare nonPARs do not have to submit claims for medicare patients

48. The "limiting charge" for nonPARs is 15% lower than that allowed for a PAR provider

49. For a medicare "simple" claim, blocks 9* through 9d are not to be reported

50. The letter "A" following a beneficiary's social security number on the HICN indicates the individual was a wage earner

51. The HMO is the most expensive and least restrictive type of medicare managed care plan

52. A private organization that administers part b claims is called a peer review organization

53. The act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness is

54. ASCA requires that all initial medicare claims be filed electronically without exception

55. When it is likely the medicare will not pay for a service or procedure, that patient should be asked to sign a/an

56. A private organization that contracts with medicare to pay part a and some of part b bills is referred to as a

57. Insurance coverage that is typically primary to medicare includes all of the following except

58. Medicares fee schedule is based on a system whereby each payment value is found within a range of payments known as

59. Medicare part d began in

60. When a medicare claim is filed, the beneficiary receives a document explaining the claim adjudication called a/an

61. The dealine for filing medicare claims is 1 year after the last date of service

62. Unlike originial medicare, medicare managed care plans often pay for items such as: ____________, __________________,_______________,___________________,_________________.

1. Managed care choices under medicare part c include_,,_,___

2. One of the cost-sharing requirements of medicare part b is an annual deductible of $_____, after which medicare pays _% of _______________

4. For medicare part a, a benefit period begins the day an individual is _____ to a hospital of SNF and ends when the beneficiary has not received care in a hospital or SNF for _ days in a row.

62. Unlike originial medicare, medicare managed care plans often pay for items such as: __, ,_,_,_____.