Health Insurance Today Chap 9 -next Step Chap 3
62 Questions
| Attempts: 76
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
Correct Answer
B. Medicare -
- 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)
Correct Answer
A. Federal insurance contribution act (FICA) -
- 3.
The are _____________ parts to the medicare program
- A.
Two
- B.
Three
- C.
Four
- D.
Five
Correct Answer
C. Four -
- 4.
Part ________ of medicare helps pay for charges incurred during an inpatient hospital stay
- A.
A
- B.
B
- C.
C
- D.
D
Correct Answer
A. A -
- 5.
Part ________ of medicare helps pay for physician and outpatient charges
- A.
A
- B.
B
- C.
C
- D.
D
Correct Answer
B. B -
- 6.
Part _____ of medicare includes the new medicare advantage options
- A.
A
- B.
B
- C.
C
- D.
D
Correct Answer
C. C -
- 7.
Part ____ of medicare helps pay for perscription drugs
- A.
A
- B.
B
- C.
C
- D.
D
Correct Answer
D. D -
- 8.
Medicare part a helps pay for all of the following except
- A.
Office visits
- B.
Home healthcare
- C.
Hospice
- D.
Blood
Correct Answer
A. Office visits -
- 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
Correct Answer
C. Beneficiary -
- 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
Correct Answer
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
Correct Answer
B. Monthly premiums -
- 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
Correct Answer
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
Correct Answer
C. Benefit period -
- 14.
Medicare part d began in
- A.
1965
- B.
1996
- C.
2002
- D.
2006
Correct Answer
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)
Correct Answer
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
Correct Answer
C. Medically necessary -
- 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
Correct Answer
A. ABN -
- 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
Correct Answer
B. RBRVS -
- 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
Correct Answer
A. Medicaid -
- 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
Correct Answer
B. MSN -
- 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
Correct Answer
C. Appeal -
- 22.
There are ______ levels to the medicare appeals process
- A.
Three
- B.
Five
- C.
Seven
- D.
Ten
Correct Answer
B. Five -
- 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
Correct Answer
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
Correct Answer
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
Correct Answer
A. CLIA -
- 26.
Coverage with medicare part c (medicare advantage plans) typically includes both part a and part b expenses
- A.
True
- B.
False
Correct Answer
A. True -
- 27.
All medicare advantage plans offer the exact same coverages as original medicare
- A.
True
- B.
False
Correct Answer
B. False -
- 28.
Under medicare part d, individual prescription drug plans must offer no less than the basic medicare coverage
- A.
True
- B.
False
Correct Answer
A. True -
- 29.
An individual cannot qualify for both medicare and medicaid
- A.
True
- B.
False
Correct Answer
B. False -
- 30.
There are 20 standard medigap policies
- A.
True
- B.
False
Correct Answer
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
Correct Answer
A. True -
- 32.
Medicare is always the "payer of last resort"
- A.
True
- B.
False
Correct Answer
B. False -
- 33.
A medicare beneficiary can sign a special release of information that is good for his/her lifetime
- A.
True
- B.
False
Correct Answer
A. True -
- 34.
Local medical review policies (LMRPs) outline general provisions for acceptance or rejection of medicare claims
- A.
True
- B.
False
Correct Answer
A. True -
- 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
Correct Answer
A. True -
- 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
Correct Answer
A. True -
- 37.
Medicare nonPARs do not have to submit claims for medicare patients
- A.
True
- B.
False
Correct Answer
B. False -
- 38.
The "limiting charge" for nonPARs is 15% lower than that allowed for a PAR provider
- A.
True
- B.
False
Correct Answer
B. False -
- 39.
For a medicare "simple" claim, blocks 9* through 9d are not to be reported
- A.
True
- B.
False
Correct Answer
A. True -
- 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
Correct Answer
A. True -
- 41.
ASCA requires that all initial medicare claims be filed electronically without exception
- A.
True
- B.
False
Correct Answer
B. False -
- 42.
The dealine for filing medicare claims is 1 year after the last date of service
- A.
True
- B.
False
Correct Answer
B. False -
- 43.
Only medicare beneficiaries can file an appeal
- A.
True
- B.
False
Correct Answer
B. False -
- 44.
A "small provider" is one with fewer that 25 full time employees
- A.
True
- B.
False
Correct Answer
A. True -
- 45.
A private organization that administers part b claims is called a peer review organization
- A.
True
- B.
False
Correct Answer
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
Correct Answer
A. True -
- 47.
Medicare now pays for certain screening procedures in their "welcome to medicare" program
- A.
True
- B.
False
Correct Answer
A. True -
- 48.
Medicare part d covers long-term (nursing home) care
- A.
True
- B.
False
Correct Answer
B. False -
- 49.
Medicare managed care plans fill the "gaps" in basic medicare similar to medigap policies
- A.
True
- B.
False
Correct Answer
A. True -
- 50.
The HMO is the most expensive and least restrictive type of medicare managed care plan
- A.
True
- B.
False
Correct Answer
B. False -
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Mar 22, 2022Quiz Edited by
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Jun 17, 2010Quiz Created by
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