Health Insurance Today Chap 9 -next Step Chap 3

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1. Managed care choices under medicare part c include_____,______,_________,_________
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2. One of the cost-sharing requirements of medicare part b is an annual deductible of $_________, after which medicare pays _______% of _________________
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3. The length of time medicare uses for hospital and skilled nursing facility (SNF) services is called a __________________.
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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.
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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
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6. 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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7. An individual cannot qualify for both medicare and medicaid
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8. Part ____ of medicare helps pay for perscription drugs
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9. The 6-month period during which and individual can sign up for the medicare program is called the open enrollment period
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10. A "small provider" is one with fewer that 25 full time employees
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11. Part _____ of medicare includes the new medicare advantage options
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12. Local medical review policies (LMRPs) outline general provisions for acceptance or rejection of medicare claims
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13. Part ________ of medicare helps pay for physician and outpatient charges
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14. Coverage with medicare part c (medicare advantage plans) typically includes both part a and part b expenses
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15. A federal insurance program, established in 1966, for people 65 years old and older and certain other qualifying individuals is
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16. The are _____________ parts to the medicare program
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17. Under medicare part d, individual prescription drug plans must offer no less than the basic medicare coverage
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18. A medicare beneficiary can sign a special release of information that is good for his/her lifetime
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19. All medicare advantage plans offer the exact same coverages as original medicare
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20. Medicare managed care plans fill the "gaps" in basic medicare similar to medigap policies
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21. After beneficiaries (who are enrolled in original medicare) satisfy the yearly deductible, they pay a 20% copayment of all "allowable" charges
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22. Medicare now pays for certain screening procedures in their "welcome to medicare" program
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23. Medicare payments can be automatically deposited into a providers designated bank account using
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24. A claim for which a beneficiary elects to assign benefits under a medigap policy is called a "mandated medigap transfer"
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25. Postpayment medicare audits are often triggered by statistical irregularities
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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
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27. Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an
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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
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29. Medicare part d covers long-term (nursing home) care
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30. Individuals pay for medicare part b coverage through
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31. Fees that medicare permits for a particular procedure, service, or supply are called
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32. Part ________ of medicare helps pay for charges incurred during an inpatient hospital stay
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33. The term used when medicare is not responsible for paying first because of coverage under another insurance policy is
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34. There are ______ levels to the medicare appeals process
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35. Medicare is always the "payer of last resort"
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36. Beneficiaries enrolled in the "original" medicare plan must pay a yearly deductible
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37. Only medicare beneficiaries can file an appeal
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38. An individual who has health insurance coverage through both the medicare and medicaid programs is commonly referred to as a
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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
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40. The act that provides for a federal system of old age, survivors, disability, and hospital insurance is the
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41. Studies performed to improve the processes and outcomes of patient care are called
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42. There are 20 standard medigap policies
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43. Medicare part a helps pay for all of the following except
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44. The medicare beneficiarys health insurance claim number (HICN) is in the format of nine numeric characters preceded by two alpha characters
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45. The first level of a medicare appeal is a telephone review
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46. When a service or procedure meets medicares criteria for coverage, it is said to be
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47. Medicare nonPARs do not have to submit claims for medicare patients
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48. The "limiting charge" for nonPARs is 15% lower than that allowed for a PAR provider
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49. For a medicare "simple" claim, blocks 9* through 9d are not to be reported
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50. The letter "A" following a beneficiary's social security number on the HICN indicates the individual was a wage earner
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51. The HMO is the most expensive and least restrictive type of medicare managed care plan
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52. A private organization that administers part b claims is called a peer review organization
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53. The act that established quality standards for all laboratory testing to ensure safety, accuracy, reliability, and timeliness is
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54. ASCA requires that all initial medicare claims be filed electronically without exception
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55. When it is likely the medicare will not pay for a service or procedure, that patient should be asked to sign a/an
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56. A private organization that contracts with medicare to pay part a and some of part b bills is referred to as a
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57. Insurance coverage that is typically primary to medicare includes all of the following except
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58. Medicares fee schedule is based on a system whereby each payment value is found within a range of payments known as
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59. Medicare part d began in
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60. When a medicare claim is filed, the beneficiary receives a document explaining the claim adjudication called a/an
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61. The dealine for filing medicare claims is 1 year after the last date of service
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62. Unlike originial medicare, medicare managed care plans often pay for items such as: ____________, __________________,_______________,___________________,_________________.
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Managed care choices under medicare part c...
One of the cost-sharing requirements of medicare part b is an annual...
The length of time medicare uses for hospital and skilled nursing...
For medicare part a, a benefit period begins the day an individual is...
Medicare part C was previously called _________________; it was...
In january of 1999, the balanced budget act (BBA) of 1997 went into...
An individual cannot qualify for both medicare and medicaid
Part ____ of medicare helps pay for perscription drugs
The 6-month period during which and individual can sign up for the...
A "small provider" is one with fewer that 25 full time employees
Part _____ of medicare includes the new medicare advantage options
Local medical review policies (LMRPs) outline general provisions for...
Part ________ of medicare helps pay for physician and outpatient...
Coverage with medicare part c (medicare advantage plans) typically...
A federal insurance program, established in 1966, for people 65 years...
The are _____________ parts to the medicare program
Under medicare part d, individual prescription drug plans must offer...
A medicare beneficiary can sign a special release of information that...
All medicare advantage plans offer the exact same coverages as...
Medicare managed care plans fill the "gaps" in basic medicare similar...
After beneficiaries (who are enrolled in original medicare) satisfy...
Medicare now pays for certain screening procedures in their "welcome...
Medicare payments can be automatically deposited into a providers...
A claim for which a beneficiary elects to assign benefits under a...
Postpayment medicare audits are often triggered by statistical...
The duration of time during which a medicare beneficiary is eligible...
Beneficiaries who are not satisfied with the amount of a claim...
Local coverage decisions (LCDs) focus exclusively on whether a service...
Medicare part d covers long-term (nursing home) care
Individuals pay for medicare part b coverage through
Fees that medicare permits for a particular procedure, service, or...
Part ________ of medicare helps pay for charges incurred during an...
The term used when medicare is not responsible for paying first...
There are ______ levels to the medicare appeals process
Medicare is always the "payer of last resort"
Beneficiaries enrolled in the "original" medicare plan must pay a...
Only medicare beneficiaries can file an appeal
An individual who has health insurance coverage through both the...
In order to qualify for medicare coverage, durable medical equipment...
The act that provides for a federal system of old age, survivors,...
Studies performed to improve the processes and outcomes of patient...
There are 20 standard medigap policies
Medicare part a helps pay for all of the following except
The medicare beneficiarys health insurance claim number (HICN) is in...
The first level of a medicare appeal is a telephone review
When a service or procedure meets medicares criteria for coverage, it...
Medicare nonPARs do not have to submit claims for medicare patients
The "limiting charge" for nonPARs is 15% lower than that allowed for a...
For a medicare "simple" claim, blocks 9* through 9d are not to be...
The letter "A" following a beneficiary's social security number on the...
The HMO is the most expensive and least restrictive type of medicare...
A private organization that administers part b claims is called a peer...
The act that established quality standards for all laboratory testing...
ASCA requires that all initial medicare claims be filed electronically...
When it is likely the medicare will not pay for a service or...
A private organization that contracts with medicare to pay part a and...
Insurance coverage that is typically primary to medicare includes all...
Medicares fee schedule is based on a system whereby each payment value...
Medicare part d began in
When a medicare claim is filed, the beneficiary receives a document...
The dealine for filing medicare claims is 1 year after the last date...
Unlike originial medicare, medicare managed care plans often pay for...
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