Deck 4: Government Payer Types

Question 1

Medicare covers beneficiaries who ________________________ and have elected to pay a premium for coverage.

A) are entitled to Social Security
B) are entitled to Railroad Retirement
C) have end-stage renal disease (ESRD)
D) both are entitled to Social Security and have ESRD
E) All of these are correct.

Answer 1

E

Question 2

A benefit period is a time frame that is part of a hospital stay until the patient is discharged. The time after the discharge and the next admission needs to be at least _________ consecutive days since the last stay in a hospital or skilled nursing facility.

A) 30
B) 60
C) 90
D) 120
E) None of these is correct.

Answer 2

B

Question 3

Under Medicare Part A, all of the following are covered items in an inpatient hospital, except:

A) room and board.
B) physician services.
C) drugs and biologicals.
D) blood products.

Answer 3

B

Question 4

In a skilled nursing facility, a Medicare Part A beneficiary receives care similar to that of an inpatient hospital at a lower level and can include:

A) rehabilitation services.
B) meals.
C) dietary counseling.
D) medical social services.
E) All of these are correct.

Question 5

There are several different types of payment adjustments in the Home Health Prospective Payment System, such as _______________________, which entails four or fewer visits paid by discipline.

A) Low Utilization Payment Adjustments (LUPA)
B) Home Health Prospective Payment System (HHPPS)
C) Partial Episode Payment (PEP)
D) None of these is correct.

Question 6

According to the Centers for Medicare and Medicaid Services (CMS), to be eligible to elect hospice care under Medicare, an individual must be entitled to Medicare Part A and be certified as:

A) homebound.
B) inpatient eligible.
C) terminally ill.
D) eligible for Medicare Part B.

Question 7

According to CMS, the timing and content for certification are for the first 90 days of hospice coverage. The hospice must obtain, no earlier than _____ days prior to care and no later than _____ calendar days after hospice is initiated, oral or written certification of the terminal illness by the medical director of the hospice or the physician member of the hospice organization.

A) 30, 10
B) 15, 2
C) 10, 10
D) 60, 15

Question 8

A hospice patient is discharged if the person:

A) is no longer terminally ill.
B) moves outside the coverage area of the servicing hospice.
C) leaves the home for a vacation.
D) moves to a new residence in the service area of the hospice agency.
E) both is no longer terminally ill and moves outside the coverage area of the servicing hospice.

Question 9

According to CMS, ESRD occurs from the destruction of normal kidney tissues over a long period of time. Often, there are no symptoms until the kidney has lost more than _____________ of its function and is usually irreversible and permanent.

A) 25%
B) 50%
C) 75%
D) 100%

Question 10

_____________________ is also known as Medicare Advantage. It is an alternative to the traditional Medicare plan for beneficiaries to choose from, instead of Medicare Part A or B.

A) Medicare Part D
B) Medicare Part C
C) Medigap
D) Both Medicare Part D and Medigap
E) None of these is correct.

Question 11

_________________ started by providing access to prescription drug discount cards for no more than $30.00 annually. Then, the program transitioned into providing subsidized access to prescription drug coverage.

A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D

Question 12

The term _________________ is used by a beneficiary to cover healthcare services that are not covered by Part A or B. These policies must meet federally imposed standards and are offered by Blue Cross and Blue Shield and various other commercial health insurance companies.

A) Medicare Part A
B) Medicare Part B
C) Medicare Part C
D) Medicare Part D
E) Medigap

Question 13

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (also known as Welfare Reform) brought about many changes, which included the implementation of:

A) HMO
B) Temporary Assistance for Needy Families (TANF)
C) Programs of All-inclusive Care for the Elderly (PACE)
D) Children's Health Insurance Program (CHIP)

Question 14

People with Amyotrophic Lateral Sclerosis (ALS) were given eligibility for Medicare, without having to wait for the customary 24-month waiting period.

Question 15

The age requirement for the HI portion of Medicare Part A is 65 years of age or older. Persons can apply for the HI benefit when they are at least 6 months away from their 65th birthday.

Question 16

An inpatient stay is defined by CMS as a person who has been admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services.

Question 17

According to CMS, in order for a patient to be eligible for home health services under Medicare Parts A and B, the physician needs to attest that the patient requires home care and is homebound.

Question 18

If while on hospice a Medicare beneficiary is in need of or requires care or hospitalization for treatment that is not related to hospice service, Medicare will not pay for this treatment.

Question 19

Hospice is generally provided for a beneficiary in their home.

Question 20

Medicare Part B covers services and supplies, such as drugs and biologicals, that are usually self-administered by the patient.

Question 21

Under Medicare Part A, dialysis supplies for in-home dialysis are covered along with drug clotting factors for hemophilia patients and prescription drugs for immunosuppressive therapy for individuals who receive an organ transplant.

Question 22

Medicare Part B is financed by monthly premiums from those beneficiaries who voluntarily enroll in the program. The funds generated by the collection of premiums are deposited in a separate account known as the Federal Supplementary Medical Trust Fund.

Question 23

The federal/state entitlement program that came out of the Title XIX of the Social Security Act that pays for medical assistance for individuals with low income is called Medicaid, which became law in 1965 and is funded only by the individual state governments.

Question 24

Mandatory Medicaid services include inpatient hospital services, outpatient hospital services, pregnancy-related services, lab and X-ray, pediatric and nurse practitioner services, and nurse-midwife services.

Question 25

Any payments from a state Medicaid program to a healthcare provider are considered as "Payment in Full."

Question 26

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive healthcare program where the Veterans Affairs (VA) shares the cost of care for covered services and supplies.