Health Insurance Today Chap 9 -next Step Chap 3

62 Questions  I  By Coofoogirl555
health insurance today chap 9 -next step chap 3
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1.  A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is
A.
B.
C.
D.
2.  The act that provides for a federal system of old age, survivors, disability, and hospital insurance is the
A.
B.
C.
D.
3.  The are _____________ parts to the medicare program
A.
B.
C.
D.
4.  Part ________ of medicare helps pay for charges incurred during an inpatient hospital stay
A.
B.
C.
D.
5.  Part ________ of medicare helps pay for physician and outpatient charges
A.
B.
C.
D.
6.  Part _____ of medicare includes the new medicare advantage options
A.
B.
C.
D.
7.  Part ____ of medicare helps pay for perscription drugs
A.
B.
C.
D.
8.  Medicare part a helps pay for all of the following except
A.
B.
C.
D.
9.  An individual who has health insurance coverage through both the medicare and medicaid programs is commonly referred to as a
A.
B.
C.
D.
10.  A private organization that contracts with medicare to pay part a and some of part b bills is referred to as a
A.
B.
C.
D.
11.  Individuals pay for medicare part b coverage through
A.
B.
C.
D.
12.  Fees that medicare permits for a particular procedure, service, or supply are called
A.
B.
C.
D.
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.
B.
C.
D.
14.  Medicare part d began in
A.
B.
C.
D.
15.  The term used when medicare is not responsible for paying first because of coverage under another insurance policy is
A.
B.
C.
D.
16.  When a service or procedure meets medicares criteria for coverage, it is said to be
A.
B.
C.
D.
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.
B.
C.
D.
18.  Medicares fee schedule is based on a system whereby each payment value is found within a range of payments known as
A.
B.
C.
D.
19.  Insurance coverage that is typically primary to medicare includes all of the following except
A.
B.
C.
D.
20.  When a medicare claim is filed, the beneficiary receives a document explaining the claim adjudication called a/an
A.
B.
C.
D.
21.  Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an
A.
B.
C.
D.
22.  There are ______ levels to the medicare appeals process
A.
B.
C.
D.
23.  Medicare payments can be automatically deposited into a providers designated bank account using
A.
B.
C.
D.
24.  Studies performed to improve the processes and outcomes of patient care are called
A.
B.
C.
D.
25.  The act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness is
A.
B.
C.
D.
26.  Coverage with medicare part c (medicare advantage plans) typically includes both part a and part b expenses
A.
B.
27.  All medicare advantage plans offer the exact same coverages as original medicare
A.
B.
28.  Under medicare part d, individual prescription drug plans must offer no less than the basic medicare coverage
A.
B.
29.  An individual cannot qualify for both medicare and medicaid
A.
B.
30.  There are 20 standard medigap policies
A.
B.
31.  The 6-month period during which and individual can sign up for the medicare program is called the open enrollment period
A.
B.
32.  Medicare is always the "payer of last resort"
A.
B.
33.  A medicare beneficiary can sign a special release of information that is good for his/her lifetime
A.
B.
34.  Local medical review policies (LMRPs) outline general provisions for acceptance or rejection of medicare claims
A.
B.
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.
B.
36.  The letter "A" following a beneficiary's social security number on the HICN indicates the individual was a wage earner
A.
B.
37.  Medicare nonPARs do not have to submit claims for medicare patients
A.
B.
38.  The "limiting charge" for nonPARs is 15% lower than that allowed for a PAR provider
A.
B.
39.  For a medicare "simple" claim, blocks 9* through 9d are not to be reported
A.
B.
40.  A claim for which a beneficiary elects to assign benefits under a medigap policy is called a "mandated medigap transfer"
A.
B.
41.  ASCA requires that all initial medicare claims be filed electronically without exception
A.
B.
42.  The dealine for filing medicare claims is 1 year after the last date of service
A.
B.
43.  Only medicare beneficiaries can file an appeal
A.
B.
44.  A "small provider" is one with fewer that 25 full time employees
A.
B.
45.  A private organization that administers part b claims is called a peer review organization
A.
B.
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.
B.
47.  Medicare now pays for certain screening procedures in their "welcome to medicare" program
A.
B.
48.  Medicare part d covers long-term (nursing home) care
A.
B.
49.  Medicare managed care plans fill the "gaps" in basic medicare similar to medigap policies
A.
B.
50.  The HMO is the most expensive and least restrictive type of medicare managed care plan
A.
B.
51.  Beneficiaries enrolled in the "original" medicare plan must pay a yearly deductible
A.
B.
52.  After beneficiaries (who are enrolled in original medicare) satisfy the yearly deductible, they pay a 20% copayment of all "allowable" charges
A.
B.
53.  The medicare beneficiarys health insurance claim number (HICN) is in the format of nine numeric characters preceded by two alpha characters
A.
B.
54.  Postpayment medicare audits are often triggered by statistical irregularities
A.
B.
55.  The first level of a medicare appeal is a telephone review
A.
B.
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 _____________________.
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