Deck 9: Medicare

Question 1

An individual who is eligible for both Medicaid and Medicare is a

A) double beneficiary
B) Medicare Part C beneficiary
C) Medi-Medi beneficiary
D) None of these

Answer 1

Medi-Medi beneficiary

Question 2

Medicare Part B deductibles, coinsurance, and some noncovered services can be covered by buying policies from federally approved private insurance carriers. These policies are known as

A) Medicare insurance policies
B) Medigap insurance policies
C) Medicaid insurance policies
D) both Medicare insurance policies and Medigap insurance policies

Answer 2

Medigap insurance policies

Question 3

Claims for Medi-Medi beneficiaries are first submitted to Medicare and then sent to Medicaid, making them known as

A) submitted claims
B) redundant claims
C) transmitted claims
D) crossover claims

Answer 3

crossover claims

Question 4

What can a provider earn via the PQRS program?

A) CMS awards
B) payment for late claims
C) additional payment
D) None of these

Question 5

PQRS is a

A) voluntary program for Medicare
B) mandatory program for all Medicare PARs
C) mandatory program for all Medicare providers
D) voluntary program for crossover claims

Question 6

Medicare is the secondary payer when the patient has

A) Medigap
B) Medicaid
C) Railroad Medicare
D) workers' compensation or federal black lung benefits

Question 7

What is Local Coverage Determination (LCD)?

A) Notices sent to physicians with information about the coding and medical necessity of a service.
B) Guide that gives local providers that are covered by Medicare
C) Form used to inform patients that a service is not likely to be reimbursed.
D) Policy stating whether and under what circumstances a service is covered.

Question 8

Which option on an ABN allows the beneficiary to receive the non-covered items and/or services and pay for them out of pocket?

A) Option 1
B) Option 2
C) Option 3
D) Option 4

Question 9

Each calendar year, Medicare enrollees must satisfy a ___________ for covered services under which Medicare Part

A) deposit
B) deductible
C) ABN
D) coinsurance

Question 10

When are physicians required to file claims for their patients who are Medicare beneficiaries?

A) only if they accept assignment
B) after the annual deductible is met
C) before the annual deductible is met
D) if the patient is treated, regardless of participation

Question 11

What do beneficiaries receive to explain the charges paid and due?

A) Receipt
B) Remittance Advise
C) Explanation of Benefits
D) Medicare Summary Notices

Question 12

Medicare coordinated care plans have which of these disadvantages?

A) physician choices limited to those in the particular plan's network
B) coverage for additional services
C) no need for a supplemental Medigap policy
D) there are no disadvantages

Question 13

The plan that combines a high-deductible fee-for-service plan with a tax-exempt trust to pay for qualified medical expenses is the

A) Medicare Savings Account (MSA)
B) Medicare Summary Notice (MSN)
C) Medical Savings Account (MSA)
D) Medical Remittance Notice (MRN)

Question 14

What national system is based on the Resource-Based Relative Value Scale (RBRVS) system using cost factors that represent the physician's time and how much it costs to run/insure a practice?

A) Medicare Remittance Notice (MRN)
B) Medicare Summary Notice (MSN)
C) Medicare Fee Schedule (MFS)
D) Medicare Savings Account (MSA)

Question 15

Physicians who agree to accept assignment for all Medicare claims and to accept Medicare's allowed charge according to the Medicare Fee Schedule as payment in full for services are classified as

A) participating
B) nonparticipating
C) subscribers
D) beneficiaries

Question 16

The Medicare Correct Coding Initiative (CCI) is designed to correct what types of errors?

A) unintentional coding errors resulting from a misunderstanding of coding
B) intentionally incorrect coding done to increase payments
C) patient misrepresentation to a physician
D) both unintentional coding error and intentionally incorrect coding done to increase payments

Question 17

Medicare law sets specific guidelines regarding what aspect of submitting claims for benefits?

A) clean claim filing
B) timely filing
C) patient invoicing
D) None of these

Question 18

Under Medicare's timely filing guidelines, when would the claim for a patient who received surgery in August of 2014 need to be filed?

A) on December 31, 2014
B) on or before December 31, 2014
C) on or before December 31, 2015
D) on or before August 31, 2015

Question 19

Late claims filed with Medicare might still be accepted if a valid explanation is given, such as

A) a staff vacation
B) an unavoidable delay
C) intentional record damage
D) forgot to send

Question 20

Before a practice provides an excluded service to a patient, the patient may be given written notification using the CMS form

A) Medicare Remittance Notice (MRN)
B) Medicare Summary Notice (MSN)
C) Advance Beneficiary Notice of Noncoverage (ABN)
D) no notice should ever be given

Question 21

If a provider thinks a procedure will not be covered by Medicare because it will be deemed not reasonable and necessary, he/she must notify the patient before the treatment using a standard

A) Advance Beneficiary Notice of Noncoverage (ABN)
B) Medicare Summary Notice (MSN)
C) Medicare Remittance Notice (MRN)
D) no notice is necessary

Question 22

When filing a late claim with Medicare, what evidence needs to be sent attached?

A) a walkout receipt
B) an RA
C) an explanation and evidence to support it
D) forgiveness letter

Question 23

A nonPAR may

A) accept assignment on a particular claim
B) balance bill patients
C) refuse to file claims
D) All of these

Question 24

Medicare beneficiaries who enroll in the Original Medicare Plan can choose

A) any licensed physician
B) in which part of Medicare they would like to participate
C) their coinsurance rates
D) any licensed physician certified by Medicare

Question 25

The amount of a patient's medical bills that has been applied to the annual deductible is shown on the

A) Medicare Remittance Notice (MRN)
B) Medicare Summary Notice (MSN)
C) Patient Enrollment Agreement
D) both MRN and MSN

Question 26

Medicare coordinated care plans are managed care policies which may offer beneficiaries which of these advantages:

A) minimal paperwork
B) coverage for the "next of kin"
C) care for treatment received while traveling overseas
D) cosmetic procedures

Question 27

What part of Medicare is authorized under the MMA, and provides voluntary Medicare prescription drug plans that are open to people who are eligible for Medicare?

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

Question 28

What part of Medicare became available in 1997 to individuals who are eligible for Part A and enrolled in Part B?

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

Question 29

A prescription drug plan has a list of drugs it covers, called a

A) formulary
B) carrier
C) hospice
D) None of these

Question 30

What is a policy that states whether and under what circumstances a service is covered?

A) MSP
B) NCD
C) ABN
D) IRA

Question 31

Under which type of Medicare plan can patients receive services from Medicare-approved providers or facilities of their choosing?

A) Medicare Savings account
B) Medicare managed care plan
C) Medicare private fee-for-service
D) Medicare coordinated plans

Question 32

What advantage do participating providers in Medicare have over those who don't?

A) they are paid 5% more
B) they are paid 10% more
C) they are processed quicker
D) they accumulate incentives

Question 33

Medicare Part D is a(n)

A) prescription drug benefit plan
B) hospice plan
C) hospital plan
D) outpatient surgery plan

Question 34

A person covered by Medicare is called a

A) subscriber
B) Medicare patient
C) Medicare beneficiary
D) member

Question 35

Insurance companies that process claims for doctors, hospitals, skilled nursing facilities, intermediate care facilities, long-term care facilities, and home health care agencies are known as

A) carriers
B) Medicare administrative contractors
C) hospices
D) None of these

Question 36

The federal health insurance program for people who are sixty-five or older is known as

A) Medicare
B) Medicaid
C) Medigap
D) Social Security

Question 37

Which section on the ABN includes the Options Box?

A) Option 1
B) Option 2
C) Section 3
D) Section 4

Question 38

An established patient is seen with a participating provider of Medicare for an office visit on August 13^th for knee pain, gets a joint injection, and the electronic claim is sent on September 1^st of the following year. The claim is sent out with an office visit code of 99213 and a diagnosis code of M25.569. No payment is sent back. What is the most probable reason why it was sent with no payment?

A) incorrect codes
B) it was not sent on a paper form
C) it was a non-participating provider
D) claim was not sent in a timely fashion

Question 39

Where on the ABN is the Signature Box?

A) Section 3
B) Section 4
C) Section 5
D) Section 6

Question 40

With the Original Medicare plan, beneficiaries are responsible for:

A) annual deductible
B) coinsurance
C) copay
D) annual deductible and coinsurance

Question 41

What do some individuals use to help pay for additional costs that Original Medicare Plan does not cover?

A) trust fund
B) Medigap
C) savings account
D) retirement fund

Question 42

A post office worker who has been working for 42 years in the same location receives his Medicare card in the mail. A year later, he is rushed to the hospital and is diagnosed as having end stage renal disease. You receive all of his paperwork and find that he has BlueCross and BlueShield insurance card from the post office and his Medicare card. Which insurance is primary?

A) BlueCross and BlueShield
B) Medigap
C) Medicare
D) retirement fund

Question 43

What is a commonly used reason for non-coverage for Medicare?

A) test too frequently
B) diagnosis
C) premium not paid
D) Medicare covers everything

Question 44

Which of these is a notice sent to physicians with information about the coding and medical necessity of a service?

A) LCD
B) IRA
C) ABN
D) MSP

Question 45

What does the Patient Protection and Affordable Care Act, or PPACA, change?

A) timely filing of claims for Part B providers
B) timely filing of claims for Part C providers
C) claims must be sent electronically
D) claims must be sent through a paper form

Question 46

When can non-participating providers decide whether to accept assignment?

A) beginning of calendar year
B) end of calendar year
C) on a claim by claim basis
D) they are required to see Medicare patients

Question 47

What do non-participating providers in Medicare get compensated if they do not accept assignment?

A) allowable charges
B) 5% less than allowable charges
C) 5% less than limited charges
D) limiting charges

Question 48

What part of Medicare allows private health insurance companies to contract with CMS to offer Medicare benefits through their own policies?

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

Question 49

What type of claim is mandated for Medicare?

A) CMS-1500
B) HCFA-1500
C) HIPAA 837
D) paper claim

Question 50

How is a secondary payer informed of what has been covered by Medicare?

A) MAC automatically forwards the claim payment data to the Medigap payer
B) by the Medicare Secondary Payer Program
C) an RA must be sent with a secondary claim
D) wait for the remittance advice before collecting any deductible

Question 51

What instructions do providers under Medicare receive regarding a patient's annual deductible?

A) collect it and refund it if it is an overpayment
B) wait for an EOB before collecting
C) file with the secondary payer first
D) wait for the remittance advice before collecting any deductible

Question 52

What is National Coverage Determination (NCD)?

A) Notices sent to physicians with information about the coding and medical necessity of a service.
B) guide that gives local providers covered by Medicare
C) Form used to inform patients that a service is not likely to be reimbursed.
D) Policy stating whether and under what circumstances a service is covered.

Question 53

What can be used to speed Medicare denials so the amount due can be collected from the patient (or a secondary payer)?

A) GY modifier
B) HU modifier
C) remittance advice
D) walkout receipt

Question 54

Which is the deadline for sending Medicare claims?

A) 18 months of the date of service
B) 12 months of the date of service
C) 6 months of the date of service
D) 3 months of the date of service

Question 55

People who are over age 65, who do not receive Social Security benefits may enroll in Medicare Part A by

A) paying a deductible
B) paying a premium
C) paying into a Medical Savings Account
D) enrolling in a Medicare HMO

Question 56

The amounts paid to PAR providers in Medicare Part B are based on the

A) MSN
B) MRN
C) MFS
D) limiting charge

Question 57

Claims for services for a Medicare/Medicaid beneficiary are called

A) service claims
B) Medicaid claims
C) Medicare claims
D) crossover claims

Question 58

Insurance that supplements the Medicare Original Plan coverage is called

A) Medigap Insurance
B) Medicaid Insurance
C) Medicoverage
D) OP Insurance

Question 59

The insurance plan that pays first when a patient is covered by more than one medical insurance plan is called the

A) primary payer
B) secondary payer
C) intermediary payer
D) principal payer

Question 60

The insurance plan that pays after the primary payer has provided benefits for a claim is called the

A) primary payer
B) secondary payer
C) intermediary payer
D) principal payer

Question 61

When a Medicare patient is also covered through an employer's group health plan, Medicare is the

A) primary payer
B) secondary payer
C) intermediary payer
D) principal payer

Question 62

People who are entitled to Medicare Part A benefits automatically qualify for Medicare

A) Part B
B) Part X
C) Part H
D) Part E

Question 63

Physicians who participate in the Medicare program can bill patients for services that are

A) covered by Medicare
B) medically necessary
C) excluded from coverage
D) they cannot bill patients

Question 64

Which is accurate about sending Medicare claims?

A) must be on paper form
B) must be sent electronically
C) an RA must be attached
D) has to be sent within 3 months of the date of service

Question 65

Under the Original Medicare Plan, what percent of the charge is the patient responsible for after paying the premium and the deductible?

A) 15 percent
B) 20 percent
C) 25 percent
D) 50 percent

Question 66

The limiting charge is what percent of the nonPAR Medicare Fee Schedule?

A) 75%
B) 85%
C) 100%
D) 115%