Health Insurance Today Chap 9 -next Step Chap 3

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

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

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.

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

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

An individual cannot qualify for both medicare and medicaid

• True

• False

Part ____ of medicare helps pay for perscription drugs

• A

• B

• C

• D

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

• True

• False

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

• True

• False

Part _____ of medicare includes the new medicare advantage options

• A

• B

• C

• D

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

• True

• False

Part ________ of medicare helps pay for physician and outpatient charges

• A

• B

• C

• D

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

• True

• False

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

The are _____________ parts to the medicare program

• Two

• Three

• Four

• Five

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

• True

• False

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

• True

• False

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

• True

• False

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

• True

• False

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

• True

• false

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

• True

• False

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

• Money orders

• Cashiers checks

• Certified deposits

• Electronic funds transfers

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

• True

• False

Postpayment medicare audits are often triggered by statistical irregularities

• True

• False

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

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

• Secondary claim

• Grievance

• Appeal

• ABN

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

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

• True

• False

Individuals pay for medicare part b coverage through

• Wage deductions

• Monthly premiums

• Personal checks

• Electronic funds transfers

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

• UR fees

• Cap limits

• Restrictive fees

• Allowable fees

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

• A

• B

• C

• D

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)

There are ______ levels to the medicare appeals process

• Three

• Five

• Seven

• Ten

Medicare is always the "payer of last resort"

• True

• False

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

• True

• false

Only medicare beneficiaries can file an appeal

• True

• False

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

• Client

• Customer

• Beneficiary

• Member

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

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)

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

• Appeals

• Peer reviews

• Redeterminations

• Quality review studies

There are 20 standard medigap policies

• True

• False

Medicare part a helps pay for all of the following except

• Office visits

• Home healthcare

• Hospice

• Blood

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

• True

• False

The first level of a medicare appeal is a telephone review

• True

• False

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

• Eligible

• Qualifying

• Medically necessary

• An entitlement

Medicare nonPARs do not have to submit claims for medicare patients

• True

• False

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

• True

• False

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

• True

• False