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Health Insurance Today Chap 9 -next Step Chap 3

62 Questions
Health Insurance Quizzes & Trivia

Review quiz mod 4 week 3

Questions and Answers
  • 1. 
    A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is
    • A. 

      Medicaid

    • B. 

      Medicare

    • C. 

      Medigap

    • D. 

      Managed care

  • 2. 
    The act that provides for a federal system of old age, survivors, disability, and hospital insurance is the
    • A. 

      Federal insurance contribution act (FICA)

    • B. 

      Health insurance portability and accountability act (HIPPA)

    • C. 

      Emergency medical treatment and active labor act (EMTLA)

    • D. 

      Consolidated omnibus budget reconciliation act (COBRA)

  • 3. 
    The are _____________ parts to the medicare program
    • A. 

      Two

    • B. 

      Three

    • C. 

      Four

    • D. 

      Five

  • 4. 
    Part ________ of medicare helps pay for charges incurred during an inpatient hospital stay
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

  • 5. 
    Part ________ of medicare helps pay for physician and outpatient charges
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

  • 6. 
    Part _____ of medicare includes the new medicare advantage options
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

  • 7. 
    Part ____ of medicare helps pay for perscription drugs
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

  • 8. 
    Medicare part a helps pay for all of the following except
    • A. 

      Office visits

    • B. 

      Home healthcare

    • C. 

      Hospice

    • D. 

      Blood

  • 9. 
    An individual who has health insurance coverage through both the medicare and medicaid programs is commonly referred to as a
    • A. 

      Client

    • B. 

      Customer

    • C. 

      Beneficiary

    • D. 

      Member

  • 10. 
    A private organization that contracts with medicare to pay part a and some of part b bills is referred to as a
    • A. 

      Beneficiary

    • B. 

      Third party

    • C. 

      Financial mediator

    • D. 

      Fiscal intermediary

  • 11. 
    Individuals pay for medicare part b coverage through
    • A. 

      Wage deductions

    • B. 

      Monthly premiums

    • C. 

      Personal checks

    • D. 

      Electronic funds transfers

  • 12. 
    Fees that medicare permits for a particular procedure, service, or supply are called
    • A. 

      UR fees

    • B. 

      Cap limits

    • C. 

      Restrictive fees

    • D. 

      Allowable fees

  • 13. 
    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
    • A. 

      Time period

    • B. 

      Limiting phase

    • C. 

      Benefit period

    • D. 

      Episode of care

  • 14. 
    Medicare part d began in
    • A. 

      1965

    • B. 

      1996

    • C. 

      2002

    • D. 

      2006

  • 15. 
    The term used when medicare is not responsible for paying first because of coverage under another insurance policy is
    • A. 

      Medigap

    • B. 

      Medi-medi

    • C. 

      Supplemental payer

    • D. 

      Medicare secondary payer (MSP)

  • 16. 
    When a service or procedure meets medicares criteria for coverage, it is said to be
    • A. 

      Eligible

    • B. 

      Qualifying

    • C. 

      Medically necessary

    • D. 

      An entitlement

  • 17. 
    When it is likely the medicare will not pay for a service or procedure, that patient should be asked to sign a/an
    • A. 

      ABN

    • B. 

      Cms-1500

    • C. 

      Release of information

    • D. 

      Assignment of benefits

  • 18. 
    Medicares fee schedule is based on a system whereby each payment value is found within a range of payments known as
    • A. 

      OOPS

    • B. 

      RBRVS

    • C. 

      Fee for service

    • D. 

      Usual, customary, and reasonable

  • 19. 
    Insurance coverage that is typically primary to medicare includes all of the following except
    • A. 

      Medicaid

    • B. 

      Group health plans

    • C. 

      Workers compensation

    • D. 

      Automobile liability insurance

  • 20. 
    When a medicare claim is filed, the beneficiary receives a document explaining the claim adjudication called a/an
    • A. 

      SPRA

    • B. 

      MSN

    • C. 

      ABN

    • D. 

      EOB

  • 21. 
    Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an
    • A. 

      Secondary claim

    • B. 

      Grievance

    • C. 

      Appeal

    • D. 

      ABN

  • 22. 
    There are ______ levels to the medicare appeals process
    • A. 

      Three

    • B. 

      Five

    • C. 

      Seven

    • D. 

      Ten

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

      Money orders

    • B. 

      Cashiers checks

    • C. 

      Certified deposits

    • D. 

      Electronic funds transfers

  • 24. 
    Studies performed to improve the processes and outcomes of patient care are called
    • A. 

      Appeals

    • B. 

      Peer reviews

    • C. 

      Redeterminations

    • D. 

      Quality review studies

  • 25. 
    The act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness is
    • A. 

      CLIA

    • B. 

      LMRP

    • C. 

      EMTLA

    • D. 

      COBRA

  • 26. 
    Coverage with medicare part c (medicare advantage plans) typically includes both part a and part b expenses
    • A. 

      True

    • B. 

      False

  • 27. 
    All medicare advantage plans offer the exact same coverages as original medicare
    • A. 

      True

    • B. 

      False

  • 28. 
    Under medicare part d, individual prescription drug plans must offer no less than the basic medicare coverage
    • A. 

      True

    • B. 

      False

  • 29. 
    An individual cannot qualify for both medicare and medicaid
    • A. 

      True

    • B. 

      False

  • 30. 
    There are 20 standard medigap policies
    • A. 

      True

    • B. 

      False

  • 31. 
    The 6-month period during which and individual can sign up for the medicare program is called the open enrollment period
    • A. 

      True

    • B. 

      False

  • 32. 
    Medicare is always the "payer of last resort"
    • A. 

      True

    • B. 

      False

  • 33. 
    A medicare beneficiary can sign a special release of information that is good for his/her lifetime
    • A. 

      True

    • B. 

      False

  • 34. 
    Local medical review policies (LMRPs) outline general provisions for acceptance or rejection of medicare claims
    • A. 

      True

    • B. 

      False

  • 35. 
    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
    • A. 

      True

    • B. 

      False

  • 36. 
    The letter "A" following a beneficiary's social security number on the HICN indicates the individual was a wage earner
    • A. 

      True

    • B. 

      False

  • 37. 
    Medicare nonPARs do not have to submit claims for medicare patients
    • A. 

      True

    • B. 

      False

  • 38. 
    The "limiting charge" for nonPARs is 15% lower than that allowed for a PAR provider
    • A. 

      True

    • B. 

      False

  • 39. 
    For a medicare "simple" claim, blocks 9* through 9d are not to be reported
    • A. 

      True

    • B. 

      False

  • 40. 
    A claim for which a beneficiary elects to assign benefits under a medigap policy is called a "mandated medigap transfer"
    • A. 

      True

    • B. 

      False

  • 41. 
    ASCA requires that all initial medicare claims be filed electronically without exception
    • A. 

      True

    • B. 

      False

  • 42. 
    The dealine for filing medicare claims is 1 year after the last date of service
    • A. 

      True

    • B. 

      False

  • 43. 
    Only medicare beneficiaries can file an appeal
    • A. 

      True

    • B. 

      False

  • 44. 
    A "small provider" is one with fewer that 25 full time employees
    • A. 

      True

    • B. 

      False

  • 45. 
    A private organization that administers part b claims is called a peer review organization
    • A. 

      True

    • B. 

      False

  • 46. 
    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
    • A. 

      True

    • B. 

      False

  • 47. 
    Medicare now pays for certain screening procedures in their "welcome to medicare" program
    • A. 

      True

    • B. 

      False

  • 48. 
    Medicare part d covers long-term (nursing home) care
    • A. 

      True

    • B. 

      False

  • 49. 
    Medicare managed care plans fill the "gaps" in basic medicare similar to medigap policies
    • A. 

      True

    • B. 

      False

  • 50. 
    The HMO is the most expensive and least restrictive type of medicare managed care plan
    • A. 

      True

    • B. 

      False

  • 51. 
    Beneficiaries enrolled in the "original" medicare plan must pay a yearly deductible
    • A. 

      True

    • B. 

      false

  • 52. 
    After beneficiaries (who are enrolled in original medicare) satisfy the yearly deductible, they pay a 20% copayment of all "allowable" charges
    • A. 

      True

    • B. 

      false

  • 53. 
    The medicare beneficiarys health insurance claim number (HICN) is in the format of nine numeric characters preceded by two alpha characters
    • A. 

      True

    • B. 

      False

  • 54. 
    Postpayment medicare audits are often triggered by statistical irregularities
    • A. 

      True

    • B. 

      False

  • 55. 
    The first level of a medicare appeal is a telephone review
    • A. 

      True

    • B. 

      False

  • 56. 
    Managed care choices under medicare part c include_____,______,_________,_________
  • 57. 
    Unlike originial medicare, medicare managed care plans often pay for items such as: ____________, __________________,_______________,___________________,_________________.
  • 58. 
    One of the cost-sharing requirements of medicare part b is an annual deductible of $_________, after which medicare pays _______% of _________________
  • 59. 
    The length of time medicare uses for hospital and skilled nursing facility (SNF) services is called a __________________.
  • 60. 
    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.
  • 61. 
    Medicare part C was previously called _________________; it was renamed by the medicare prescription, improvement, and modernization act of 2003 (MMA) and is now called
  • 62. 
    In january of 1999, the balanced budget act (BBA) of 1997 went into effect expanding the role of private plans to include _____________________.