Question 1

Certain organ transplants are covered under Part A as long as:

Accepted Answer

Part A covers certain organ transplants if the services are performed in a hospital that is an approved Medicare provider.

Question 2

The types of Medicare Advantage managed care plans include:

Accepted Answer

Medicare Advantage managed care plans include both PPO and HMO plans, as well as local PPO plans specifically. Traditional fee-for-service plans are not part of the Medicare Advantage program.

Question 3

For a service to be considered medically necessary by Medicare, which of the following criteria must be met?

Accepted Answer

Medicare considers a service to be medically necessary if it is delivered at the most appropriate level of care necessary to diagnose or treat the patient's condition. Elective procedures, investigational procedures, and procedures performed for the patient's convenience are not considered medically necessary.

Question 4

Private-duty nursing care is:

Accepted Answer

Private-duty nursing care is not covered by Medicare. This type of care involves a registered nurse or licensed practical nurse providing one-on-one care to a patient in their home. This is typically considered a non-medical service and is not covered by traditional Medicare. However, some Medicare Advantage plans may offer coverage for private-duty nursing care as an added benefit.

Question 5

Which of the following services is covered by Medicare Part A or Part B?

Accepted Answer

Physical therapy is covered by both Medicare Part A and Part B. Acupuncture, dental care, and routine eye care are not covered by either Medicare Part A or Part B.

Question 6

The Program of All-Inclusive Care for the Elderly (PACE) is a program for low-income elderly individuals that is:

Accepted Answer

PACE is a joint Medicare-Medicaid program that provides comprehensive medical and social services for elderly individuals who require a nursing home level of care but wish to continue living in their communities. It is not funded by private insurers or run by individual states.

Question 7

Medicare Part D consists of:

Accepted Answer

Medicare Part D specifically covers prescription drugs. It does not cover home healthcare, wellness, or long-term care.

Question 8

The Physician Value-Based Payment Modifier:

Accepted Answer

The Physician Value-Based Payment Modifier adjusts a physician or physician group's Medicare fee schedule payments based on performance.

Question 9

Items that are NOT covered by Medicare Part A or Part B include:

Accepted Answer

The answer of Items that are NOT covered by Medicare...

Question 10

When a provider has agreed to accept the allowed charge for a service as payment in full, it is known as:

Accepted Answer

When a provider accepts assignment, they agree to accept the allowed charge as payment in full, and cannot bill the patient for any additional amount. This is a common practice in the Medicare program. Discounted billing may refer to offering a reduced rate for services, but it does not necessarily mean that the provider has agreed to accept the allowed charge as payment in full. Accepting contract terms is a general concept and does not specifically relate to payment. Fraud is not a valid option.

Question 11

The original Medicare plan is based on which type of payment method?

Accepted Answer

The original Medicare plan is based on the fee-for-service payment method, in which healthcare providers are reimbursed for each service or procedure they provide to a Medicare beneficiary.

Question 12

Medicare Part B providers agree to accept as payment in full the amount paid by:

Accepted Answer

Medicare Part B providers agree to accept payment in full from Medicare, as well as the patient's share of the cost, which is typically the 20% coinsurance amount. Medicare Advantage plans may have different payment arrangements with providers.

Question 13

Medicare Part B insurance helps pay for all of the following services EXCEPT:

Accepted Answer

Medicare Part B does not cover routine foot care unless it is related to a medical condition such as diabetes.

Question 14

Medicare patients with Part B fee-for-service benefits are responsible for what percentage of the Medicare Fee Schedule (MFS) after the deductible has been met and services are rendered by a provider who accepts assignment?

Accepted Answer

Medicare patients with Part B fee-for-service benefits are responsible for 20% of the Medicare Fee Schedule (MFS) after the deductible has been met and services are rendered by a provider who accepts assignment.

Question 15

As of 2016, the standard Medicare Part B premium is:

Accepted Answer

As of 2016, the standard Medicare Part B premium is $121.80. This premium amount may vary based on income and other factors.

Question 16

Medicare Part B covers:

Accepted Answer

Medicare Part B covers annual wellness visits and preventive screenings, but not custodial care, prescription drugs, or acupuncture.

Question 17

All of the following are considered physicians by Medicare EXCEPT a(n):

Accepted Answer

Physical therapists are not considered physicians by Medicare. Physicians typically include doctors of medicine (MDs), doctors of osteopathy (DOs), optometrists, and dentists (doctor of dental medicine or surgery), among others, but physical therapists do not have the same level of training or scope of practice as these other healthcare professionals.

Question 18

To obtain Medicare Part B coverage, individuals must qualify by meeting eligibility requirements for Part A or:

Accepted Answer

The answer of To obtain Medicare Part B coverage, individuals...

Question 19

A physician who chooses NOT to participate in a Medicare health plan is known as a:

Accepted Answer

A physician who chooses not to participate in a Medicare health plan is known as a nonparticipating provider. This means that they can still choose to provide services to Medicare beneficiaries, but they are not bound by Medicare's fee schedule and can charge more for their services. Additionally, Medicare will only cover 80% of the approved amount for services received from a nonparticipating provider, leaving the remaining 20% to be paid by the beneficiary or their supplemental insurance.

Question 20

Types of Medicare Part C plans include:

Accepted Answer

All of the above options (HMO, PPO, and fee-for-service) are types of Medicare Part C plans. The best choice will depend on individual needs and preferences, so it is important for individuals to research and compare the different plans available to them.

Quiz 12: Medicare Medical Billing