Deck 4: The Payment Process: Government Payment Programs

Question 1

Which of the following people may be eligible for workers' compensation?

A) Julie has an accident on her way to work.
B) Jan hurt herself while vacationing at the resort where she works as a cook.
C) Steve fell in the restaurant parking lot on his lunch break.
D) Scott heard an odd popping noise as he transferred a patient from the bed to the chair on 4 East where he works as an RN.

Answer 1

Scott heard an odd popping noise as he transferred a patient from the bed to the chair on 4 East where he works as an RN.

Question 2

Office of Personnel Management administers this program:

A) Medicare
B) FEHBP
C) Medicaid
D) SCHIP

Answer 2

FEHBP

Question 3

Which of the following are likely eligible for Medicaid?

A) The indigent
B) Children
C) The elderly
D) The wealthy

Answer 3

The indigent

Question 4

Medicare is administered by:

A) CMS.
B) the states.
C) OPM.
D) FEHBP.

Question 5

Susie Coder is a hospital inpatient coder. She is coding a complex Medicare record. She has to choose between two codes for the bill. Code A pays $3,400. Code B pays $9,700. The coding rules indicate that Susie should use code A. Susie uses code B. Susie is guilty of:

A) miscoding.
B) hospital coding.
C) DRG coding.
D) upcoding.

Question 6

Which of the following people is most likely medically needy?

A) 35-year-old healthy mother of one
B) 70-year-old nursing home resident
C) 66-year-old retired corporate executive with controlled hypertension
D) 2-year-old child with a genetic disorder who has two gainfully employed parents

Question 7

Coding a service so that it is paid for even though it was not done is an example of:

A) an abusive activity.
B) an untrained coder.
C) a fraudulent activity.
D) a sympathetic physician.

Question 8

The category of Medicaid recipients who receive the largest amount of funding is:

A) the disabled.
B) the elderly.
C) adults.
D) children.

Question 9

Medicaid eligibility is:

A) decided on a federal level.
B) decided on a state level.
C) the same for all states.
D) determined based on education .

Question 10

Workers' compensation is financed by:

A) employer and employee payments.
B) employer payments only.
C) employee and government payments.
D) employer and government payments.

Question 11

Hospitalization for a 70-year-old woman is likely covered by:

A) Medicaid Part B.
B) Medicaid Part A.
C) Medicare Part A.
D) Medicare Part B.

Question 12

Medicare covers all of the following except:

A) long-term care.
B) hospital care.
C) physician care.
D) hospice.

Question 13

Insurance for military personnel is:

A) Medicare.
B) Medicaid.
C) TRICARE.
D) CHAMPUS.

Question 14

All of the following are true about compliance programs except:

A) all claims submitted for payment must have appropriate documentation.
B) providers should receive regular training to stay current with Medicare and Medicaid regulations.
C) they are mandatory under the Patient Protection and Affordable Care Act.
D) upcoding is encouraged.

Question 15

Medicaid is a:

A) state-funded, state-administered program.
B) federally funded, federally administered program.
C) state-funded, federally administered program.
D) federally funded, state-administered program.

Question 16

Medicare _______________ adopted(ing) managed care strategies.

A) is considering
B) was the most recent of the large insurers that
C) will not be
D) was the first insurer that

Question 17

A physician office visit for a 9-year-old whose mother makes minimum wage and can't afford to pay her portion of her employer's health insurance plan may be covered by:

A) Medicare Part B.
B) SCHIP.
C) Medicaid.
D) Medicare Part A.

Question 18

The typical Medicaid recipient is a:

A) greater than 65-year-old white person.
B) less than 65-year-old ethnic minority person.
C) less than 18-year-old white person.
D) greater than 18 but less than 65-year-old white person.

Question 19

All of the following are eligible for SCHIP except:

A) a 2-year-old child.
B) an 18-year-old person.
C) a 19-year-old person.
D) an unborn child.

Question 20

Dr. Kay is a major stockholder in Clinilabs. Because she is familiar with the lab, she sends all of her specimens to them. She can:

A) bill Medicare and another insurance.
B) bill Medicare for payment.
C) continue this practice; it demonstrates her commitment to quality health care.
D) not bill Medicare for payment.

Question 21

List two groups eligible for the FEHBP.

Question 22

TRICARE is a provider of health care services.

Question 23

Financial gain from patient/service referrals is known as _______________.

Question 24

Describe workers' compensation. Include the rationale for its existence from an employer and employee perspective.

Question 25

The following are covered under the FEHBP:

A) federal employees.
B) military families.
C) the indigent.
D) those with end-stage renal disease.

Question 26

Medicare is administered by _______________.

Question 27

When providers feel that financial incentives are inadequate, they may opt out of:

A) CHAMPUS
B) SCHIP
C) Medicaid
D) FEHBP

Question 28

In 2008 the largest Medicare provider expenditure occurred in the following category:

A) hospital.
B) skilled nursing facility.
C) home health agency.
D) hospice.

Question 29

The government as a payer of health care services has significant power in the health care delivery system. Identify and explain two of the three issues for government payment programs noted in the text. Include an example of each in your explanation.

Question 30

Health care providers must accept Medicaid patients.
30. An example of self-referral would be physicians making referrals to a lab facility in which they were partial owners.

Question 31

The disease that makes a person eligible for Medicare without being over 65 years old is ________________.

Question 32

All of the following describe the 2010 Patient Protection and Affordable Care Act regarding fraud and abuse except:

A) there will be enhanced oversight of new providers.
B) there will be provider screening.
C) a database to share information across states and federal programs is being developed.
D) penalties for false claims will be decreased.

Question 33

In all but a few states, more than 50% of the Medicaid population is in managed care.

Question 34

Physician's Medicare payments are paid based on limits set by _______________.

Question 35

In 2008 the total number of Medicare enrollees was:

A) 15 million.
B) 25 million.
C) 35 million.
D) 45 million.

Question 36

Hospitals are the largest recipients of workers' compensation dollars.