Deck 12: Medicare Medical Billing

Question 1

To qualify for Medicare, disabled adults must have been receiving Social Security disability benefits for:

A) 1 year.
B) more than 1 year.
C) more than 2 years.
D) more than 3 years.

Answer 1

more than 2 years.

Question 2

The organization that enrolls new Medicare beneficiaries into the program is the:

A) Centers for Medicare and Medicaid Services (CMS).
B) Department of Health and Human Services (DHHS).
C) Internal Revenue Service (IRS).
D) Social Security Administration (SSA).

Answer 2

Social Security Administration (SSA).

Question 3

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers to continue group health insurance coverage after employment ends for a minimum of:

A) 6 months.
B) 12 months.
C) 18 months.
D) 24 months.

Answer 3

18 months.

Question 4

Organizations that are hired by the CMS to carry out day-to-day Medicare program operations are known as:

A) administrators.
B) contractors.
C) intermediaries.
D) carriers.

Question 5

The Medicare coverage that pays for physician services is:

A) Medicare Part A.
B) Medicare Part B.
C) Medicare Part D.
D) Medicare Advantage (MA).

Question 6

The Medicare program that provides expanded benefits through private managed care health plans is:

A) Medicare Part A.
B) Medicare Part B.
C) Medicare Part D.
D) Medicare Advantage (MA).

Question 7

For each benefit period, a Medicare Part A beneficiary will receive coverage for:

A) 30 days of hospital care.
B) 60 days of hospital care.
C) 90 days of hospital care.
D) unlimited days of hospital care if medically necessary.

Question 8

Coverage for hospice care is provided by:

A) Medicare Part A.
B) Medicare Part B.
C) Medicare Part D.
D) Medicare Advantage (MA).

Question 9

A spouse of a deceased, retired, or disabled individual who was or is eligible for Medicare benefits:

A) is not eligible for Medicare coverage.
B) is also eligible for Medicare coverage.
C) must apply for Medicaid benefits.
D) is eligible for Supplemental Security Income benefits.

Question 10

Individuals eligible for Medicare may be classified into one or more of the following categories EXCEPT:

A) age 65 or older.
B) disabled.
C) low income.
D) end-stage renal disease.

Question 11

The abbreviation ESRD stands for:

A) ending symptoms of renal disease.
B) early status of respiratory distress.
C) end-stage respiratory distress.
D) end-stage renal disease.

Question 12

Under Medicare Part A, what time limit applies to coverage for home healthcare services?

A) 60 days per benefit period
B) 90 days per benefit period
C) 120 days per benefit period
D) There is no time limit as long as medical necessity has been proven.

Question 13

For Medicare Part A, a deductible applies:

A) to each benefit period.
B) to each household.
C) to each hospital admission.
D) only if skilled nursing care is provided.

Question 14

For each benefit period, a Medicare Part A beneficiary will receive coverage for how many days of skilled nursing care?

A) 30 days
B) 60 days
C) 90 days
D) 100 days

Question 15

Medicare prescription drug coverage is offered through:

A) Medicare Part A.
B) Medicare Part B.
C) Medicare Part D.
D) Medicare Advantage (MA).

Question 16

The Medicare coverage that consists of hospital insurance is:

A) Medicare Part A.
B) Medicare Part B.
C) Medicare Part D.
D) Medicare Advantage (MA).

Question 17

Individuals age 65 and older qualify for Medicare if they have paid FICA taxes for at least:

A) 10 calendar quarters.
B) 25 calendar quarters.
C) 40 calendar quarters.
D) 50 calendar quarters.

Question 18

When receiving inpatient hospital care, a Medicare Part A beneficiary has a lifetime reserve of:

A) 30 days.
B) 60 days.
C) 90 days.
D) unlimited days if medically necessary.

Question 19

Medicare Part A provides coverage for all of the following services EXCEPT:

A) inpatient hospital care.
B) telemedicine.
C) home healthcare.
D) hospice care.

Question 20

Hospice services covered under Medicare Part A may be provided as:

A) short-term hospital care.
B) inpatient respite care.
C) in-home care.
D) all of the above.

Question 21

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

A) a second opinion has been obtained before the surgery.
B) services are performed in a hospital that is an approved Medicare provider.
C) the patient has not exceeded his or her Part A benefit limit.
D) an in-home caregiver will be available to care for the patient after surgery.

Question 22

The types of Medicare Advantage managed care plans include:

A) Local PPO plans.
B) HMO plans.
C) PPO and HMO plans.
D) traditional fee-for-service plans.

Question 23

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

A) It is delivered at the most appropriate level.
B) It is an elective procedure.
C) It is an investigational procedure.
D) It is performed for the patient's convenience.

Question 24

Private-duty nursing care is:

A) covered by Medicare Part A.
B) covered by Medicare Part B.
C) covered by Medicare Part C.
D) not covered by Medicare.

Question 25

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

A) Acupuncture
B) Dental care
C) Routine eye care
D) Physical therapy

Question 26

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

A) a Medicaid program.
B) a joint Medicare-Medicaid program.
C) a program funded by private insurers.
D) a state-run program.

Question 27

Medicare Part D consists of:

A) home healthcare coverage.
B) wellness coverage.
C) prescription drug coverage.
D) long-term care coverage.

Question 28

The Physician Value-Based Payment Modifier:

A) adjusts a physician or physician group's Medicare fee schedule payments based on performance.
B) must be applied to all physicians and physician groups by 2020.
C) gives financial incentives that are based on performance every 5 years.
D) is a voluntary system that provides incentives to providers based on performance.

Question 29

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

A) long-term care, such as custodial care in a nursing home.
B) care in a skilled nursing facility (SNF) after a 3-day hospital stay.
C) care provided by a rural health clinic.
D) home healthcare.

Question 30

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

A) discounted billing.
B) accepting assignment.
C) accepting contract terms.
D) fraud.

Question 31

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

A) Per diem
B) Capitation
C) Fee-for-service
D) Sliding scale

Question 32

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

A) Medicare only.
B) Medicare plus the patient's share.
C) Medicare and Medicaid.
D) the patient only.

Question 33

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

A) outpatient hospital services.
B) clinical laboratory services.
C) routine foot care.
D) ambulance transportation.

Question 34

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?

A) 15%
B) 20%
C) 25%
D) 30%

Question 35

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

A) $92.34.
B) $121.80.
C) $156.90.
D) $178.13.

Question 36

Medicare Part B covers:

A) annual physical examinations.
B) prescription drugs.
C) acupuncture.
D) custodial care.

Question 37

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

A) doctor of osteopathy.
B) optometrist.
C) doctor of dental medicine.
D) physical therapist.

Question 38

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

A) qualifying as a disabled individual.
B) purchasing Part D coverage.
C) purchasing Part A coverage.
D) qualifying based on income status.

Question 39

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

A) noncontracting provider.
B) nonpracticing provider.
C) nonproviding provider.
D) nonparticipating provider.

Question 40

Types of Medicare Part C plans include:

A) health maintenance organization (HMO) plans.
B) preferred provider organization (PPO) plans.
C) fee-for-service plans.
D) all of the above.

Question 41

Medicare beneficiaries include individuals age 65 and older and low-income individuals.

Question 42

A Medicare Remittance Notice informs the provider of:

A) the amount of payment.
B) adjustments that were made.
C) the amount the patient owes.
D) all of the above.

Question 43

Physicians who are NOT participating and NOT accepting assignment from Medicare can charge:

A) the usual, customary, and reasonable fee for services.
B) no more than 115% of the nonparticipating provider Medicare Fee Schedule (MFS).
C) the rate as shown on the nonparticipating provider Medicare Fee Schedule (MFS).
D) no more than 110% of the nonparticipating provider Medicare Fee Schedule (MFS).

Question 44

When referring to Medicare, MSP refers to:

A) Medical specialty providers.
B) Medicare supplement plans.
C) Medicare secondary payer.
D) Medicare services and plans.

Question 45

Which of the following information is NOT included on a Medicare beneficiary's identification card?

A) Effective date of coverage
B) Primary care physician's name
C) Claim number
D) Type of coverage

Question 46

Which of the following is true of nonparticipating providers who accept assignment?

A) They receive 10% lower fees for services than participating providers.
B) They have access to beneficiary eligibility information.
C) They are required to file Medicare claims on behalf of Medicare patients.
D) They receive 15% lower fees for services than participating providers.

Question 47

Part C is the Medicare option that allows beneficiaries to enroll in their choice of managed care plan, known as a Medicare Advantage plan.

Question 48

Part A provider certification is obtained through formal inspections by state agencies.

Question 49

An additional health insurance policy sold by a private carrier that provides limited coverage for services that Medicare does NOT cover is known as a:

A) Medicare Part C plan.
B) Medicare secondary plan.
C) Medicaid plan.
D) Medigap plan.

Question 50

Individuals with ESRD are Medicare eligible.

Question 51

In which of the following cases involving a patient who is age 65 or older is Medicare considered the primary payer?

A) The patient's condition is the result of an automobile accident.
B) The patient works for an employer with 20 or fewer employees.
C) The patient has group health insurance through a working spouse.
D) The patient's injury or condition is covered by workers' compensation.

Question 52

Only Medicare participating providers are required to file claims on behalf of Medicare patients.

Question 53

The Medicare Part B premium is determined by the patient's annual income.

Question 54

The types of Medicare Advantage plans include HMOs.

Question 55

The Medicare program is administered by the Centers for Medicare and Medicaid Services (CMS), a division of the United States Department of Health and Human Services.

Question 56

Hearing aids are NOT routinely covered by Medicare.

Question 57

A Medicare beneficiary has a lifetime reserve of 90 days of coverage that can be used to cover inpatient hospital services.

Question 58

All Medicare beneficiaries are automatically enrolled in Medicare Part D.

Question 59

Medicare is considered the primary payer when an individual age 65 or older:

A) is eligible for coverage through the Veterans Administration.
B) receives treatment for an accident-related claim.
C) fails to apply for end-stage renal disease (ESRD)-based coverage.
D) is covered by another policy that is NOT a group policy.

Question 60

Medicare Part B covers telemedicine.

Question 61

If the patient's name is misspelled on the Medicare ID card, the correct spelling should be used on the claim form.

Question 62

When an individual has Medicare and a Medigap policy, the reassignment of the gaps in coverage is known as ________.

Question 63

Nonparticipating providers who collect amounts from patients in excess of the limiting charge are subject to financial penalties.

Question 64

The form sent to patients by the Medicare contractor (carrier) that itemizes services billed to Medicare, the amount paid, and the amount the beneficiary is responsible for (if any) is a(n) ________ Notice.

Question 65

The coding system used to report procedures and services for Medicare patients is the ________ Coding System.

Question 66

The ________ extended Medicare coverage of remote patient monitoring (RPM) services for covered chronic health conditions, and home dialysis services for those with end-stage renal disease.

Question 67

Routinely waiving coinsurance and/or deductibles for Medicare patients when the patient has the ability to pay is considered abuse.

Question 68

Offering, accepting, or soliciting bribes, rebates, or kickbacks is considered fraud.

Question 69

The ________ notice is a notification to a Medicare patient that the services to be provided may NOT be covered by Medicare because they are NOT medically necessary, and the patient is responsible for the charges.

Question 70

Telemedicine, also called ________, has become an option for urban areas with populations up to 100,000 with limited access to healthcare providers.

Question 71

When Medicare is the secondary payer, a copy of the primary insurance remittance notice must be submitted with the claim.

Question 72

If a patient is more than 65 years old and is receiving coverage under COBRA, Medicare is the primary payer.

Question 73

Once a Medicare patient has been hospitalized for 60 consecutive days in a benefit period, they must pay ________ if they remain in the hospital.

Question 74

Nonparticipating providers who accept assignment receive 100% of the applicable MFS.

Question 75

A Medicare ________ is sent to a provider when a Medicare claim has been filed but needs additional information or documentation before the claim can be processed and paid.

Question 76

If a veteran is entitled to Medicare benefits, he or she may choose whether to receive coverage through Medicare or through the Veterans Administration.

Question 77

Notices sent to physicians on a regular basis that contain detailed and updated information about the coding and medical necessity of a specific service are ________ Determinations.

Question 78

Knowingly and willfully executing a scheme to defraud any healthcare benefit program is considered ________.

Question 79

When a Medicare patient is covered by more than one plan and Medicare is clearly NOT the primary payer, the type of claim submitted to Medicare is a Medicare ________ payer claim.

Question 80

The Medicare document that patients sign to authorize the release of information for claims processing and payment is the ________ Claim Authorization and Information Release form.