Deck 12: Medicare

Question 1

Medicare is a

A) state health insurance program.
B) federal health insurance program.
C) regional health insurance program.
D) local health insurance program.

Answer 1

federal health insurance program.

Question 2

When a Medicare patient signs an advance beneficiary notice, the procedure code for the service provided must be modified using the HCPCS Level II modifier

A) -LA.
B) -HB.
C) -GA.
D) -GB.

Answer 2

-GA.

Question 3

Medicare provides a onetime baseline mammographic examination for women ages 35-39 and preventive mammogram screenings for women 40 years or older

A) once a year.
B) every other year.
C) once every 3 years.
D) once every 5 years.

Answer 3

once a year.

Question 4

The frequency of Pap tests that may be billed for a Medicare patient who is low risk is

A) once every 12 months.
B) every other year.
C) once every 24 months.
D) once every 5 years.

Question 5

The Medicare Part A benefit period ends when a patient

A) is discharged from the hospital.
B) has not been a bed patient in any hospital or nursing facility for 60 consecutive days.
C) has not been a bed patient in any hospital or nursing facility for 30 consecutive days.
D) has not been a bed patient in any hospital or nursing facility for 90 consecutive days.

Question 6

A participating physician with the Medicare plan agrees to accept

A) 80% of the billed amount.
B) 80% of the physician's usual and customary charges.
C) 80% of the limiting charge.
D) 80% of the Medicare-approved charge.

Question 7

Medigap insurance may cover

A) all physician and hospital deductibles.
B) the deductible not covered under Medicare.
C) 80% of the Medicare allowed amount.
D) 75% of the Medicare allowed amount.

Question 8

In the Medicare program, there is mandatory assignment for

A) clinical laboratory tests.
B) surgery performed in the physician's office.
C) ECGs.
D) E/M services.

Question 9

Some senior HMOs may provide services not covered by Medicare, such as

A) laboratory and x-ray services.
B) vaccines and ambulance services.
C) mammograms and Pap smears.
D) eyeglasses and prescription drugs.

Question 10

A program that contracts with CMS to review medical necessity and appropriateness of inpatient medical care is known as a

A) QIO.
B) PCP.
C) HMO.
D) HHS.

Question 11

The Part B Medicare annual deductible is

A) $60.
B) $162.
C) $150.
D) $760.

Question 12

When a Medicare beneficiary has employer supplemental coverage, Medicare refers to these plans as

A) Medigap.
B) Medicaid.
C) MSP.
D) LGHP.

Question 13

Medicare Part B

A) diagnostic tests.
B) hospital rooms.
C) hospice care.
D) nursing facility care.

Question 14

A Medicare prepayment screen

A) identifies claims to review for medical necessity.
B) monitors the number of times given procedures can be billed during a specific time frame.
C) both a and b.
D) neither a nor b.

Question 15

The letters preceding the number on the patient's Medicare identification card indicate

A) wage earner, husband's number, widow, and disabled adult.
B) outpatient or hospital benefits.
C) railroad retiree.
D) Medicaid eligibility.

Question 16

Payments to hospitals for Medicare services are classified according to

A) CPT codes.
B) ICD-9-CM codes.
C) DRGs.
D) PTMs.

Question 17

Under the prospective payment system (PPS), hospitals treating Medicare patients are reimbursed according to

A) a new fee schedule established in 1983.
B) preestablished rates for each type of illness treated based on diagnosis.
C) preestablished rates for each type of hospital stay based on services.
D) a hospital capitation plan.

Question 18

The letter "D" following the identification number on the patient's Medicare card indicates a

A) disabled adult.
B) disabled child.
C) wage earner.
D) widow.

Question 19

Medicare Part A

A) physician outpatient medical services.
B) blood transfusions.
C) physical therapy.
D) hospice care.

Question 20

Medicare Part A is administered by

A) the local Social Security Administration office.
B) a regional fiscal intermediary.
C) the Centers for Medicare and Medicaid Services.
D) the National Blue Cross Association.

Question 21

The HCPCS national alphanumeric codes are referred to as

A) Level I codes.
B) Level II codes.
C) Level III codes.
D) Level IV codes.

Question 22

For all elective surgeries for which the actual charge will be ____________________ or more, a Medicare nonparticipating physician who does not accept assignment must provide the beneficiary in writing with the estimated fee for any elective surgery, the estimated Medicare-approved allowance for the surgery, and the cost difference between the approved allowance and the Medicare limiting charge.

Question 23

When a Medicare patient's payment authorization is on file, the abbreviation ____________________ may be used on the CMS-1500 claim form.

Question 24

The alpha letter ____________________ following the identification number on a female patient's Medicare card indicates that it is her husband's number.

Question 25

An NPI number issued to a provider by CMS is the acronym for _________________________.

Question 26

A specialized insurance policy that is predefined by the federal government for the Medicare beneficiary to cover the deductible and copayment amounts is referred to as _________________________.

Question 27

When a Medicare carrier transmits a Medigap claim electronically to the Medigap carrier, it is referred to as a/an

A) electronic carryover claim.
B) crossover claim.
C) referral claim.
D) Medi-Medi claim.

Question 28

Medicare outpatient coverage is referred to as Part ____________________.

Question 29

Medicare provides insurance for people ____________________ years of age or older who are retired on Social Security.

Question 30

A Medicare nonparticipating physician may bill no more than the Medicare ____________________.

Question 31

When a remittance advice (RA) is received from Medicare, the insurance billing specialist should

A) post the entire lump sum to the daysheet.
B) post each patient's name and the amount of payment on the daysheet and the patient's ledger card.
C) deposit the check and then post all accounts as time permits.
D) not post the payment unless all accounts are paid on the RA according to the Medicare fee schedule.

Question 32

If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist should

A) deposit the check and then write to Medicare to acknowledge the overpayment.
B) deposit the check and wait for Medicare to notify the physician of the mistake.
C) send the check back to Medicare with an explanation of the overpayment.
D) set the check aside until the overpayment issue has been resolved.

Question 33

An explanation of benefits document for a patient under the Medicare program is referred to as the

A) Medicare remittance advice document.
B) reimbursement report.
C) summary payment report.
D) explanation of Medicare benefits.

Question 34

Organizations handling claims from physicians and other suppliers of services covered under Medicare Part B are called fiscal intermediaries or ____________________.

Question 35

The time limit for submitting a Medicare claim is

A) the end of the calendar year following the fiscal year in which services were performed.
B) the end of the calendar year in which the service was performed.
C) within 6 months from the date of service.
D) within 1 year from the date of service.

Question 36

The Civil Monetary Penalties Law carries a sanction for a penalty of ____________________ for a physician who fails to electronically transmit or manually submit a Medicare claim.

Question 37

Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called

A) local intermediaries.
B) regional intermediaries.
C) fiscal intermediaries.
D) fiscal agents.

Question 38

The Medicare HCPCS coding system has ____________________ levels.

Question 39

A claims assistance professional (CAP)

A) may act on the Medicare beneficiary's behalf as a client representative.
B) is an individual chosen by the SSA to receive and administer SSA benefits on behalf of the Medicare beneficiary.
C) is not recognized by Medicare to act on behalf of the beneficiary.
D) does not have any legal standing to act on behalf of the beneficiary.

Question 40

The 1987 Omnibus Budget Reconciliation Act (OBRA) established the

A) MAAC.
B) DRG.
C) CPT.
D) RBRVS.

Question 41

Medicare covers some services by chiropractors.

Question 42

The number of Medicare benefit periods a patient can have for hospital care is limited.

Question 43

What does TEFRA stand for?

Question 44

Patients who elect Medicare Part B coverage pay annually increasing basic premium payments.

Question 45

When Medicare payments are posted to a separate daysheet, what should the daysheet payment total agree with?

Question 46

Medicare provides insurance for disabled workers of any age.

Question 47

Medicare Part A is called supplementary medical insurance (SMI).

Question 48

In the Medicare program, a physical examination is a covered benefit when performed within 12 months of enrollment.

Question 49

On what basis are HMO enrollees classified into DCGs?

Question 50

Scenario: The following questions pertain to a participating physician who bills Medicare $480; Medicare allows $400, and the patient has met the Medicare deductible for the calendar year.
What is the amount of the check that Medicare sends to the physician?

Question 51

Medicare provides insurance for disabled individuals if they have received Social Security disability benefits for 24 months.

Question 52

It is possible for an alien to be eligible for Medicare Part A and Part B.

Question 53

All persons age 65 who meet eligibility requirements for Medicare receive Medicare Part B (outpatient coverage).

Question 54

What type of coverage does a Medi-Medi patient have?

Question 55

Employee and employer contributions help pay for Medicare Part A health services.

Question 56

Scenario: The following questions pertain to a participating physician who bills Medicare $480; Medicare allows $400, and the patient has met the Medicare deductible for the calendar year.
What is the courtesy adjustment?

Question 57

Funds for Medicare Part B come equally from those who sign up for it and the federal government.

Question 58

Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility.

Question 59

Scenario: The following questions pertain to a participating physician who bills Medicare $480; Medicare allows $400, and the patient has met the Medicare deductible for the calendar year.
What is the patient's financial responsibility?

Question 60

A patient classified with ESRD may be provided benefits from Medicare. What does ESRD stand for?

Question 61

Medigap payments go directly to the beneficiary.

Question 62

Because Medicare is a federal program providing uniform benefits, payment of each medical service rendered to Medicare patients is consistent across the United States.

Question 63

Medicare Part B insurance payments are all handled by the National Blue Cross Association.

Question 64

Nonparticipating physicians have an option regarding accepting assignment on the Medicare patient.

Question 65

The patient's authorized signature is not required on the CMS-1500 claim form for Medicare-Medicaid cases.

Question 66

Once a patient changes from Medicare to a senior HMO, the patient may change plans during an open enrollment period in the spring of each year.

Question 67

Benefits of Medigap policies may vary from one state to another.

Question 68

A nonparticipating physician who is not accepting assignment may bill any fee he or she wants.

Question 69

When a Medicare recipient chooses a Medicare senior plan, he or she forfeits the Medicare card.

Question 70

Medicare's remittance advice document was formerly known as the explanation of Medicare benefits.

Question 71

When a CMS-1500 claim form is automatically transferred by Medicare to a Medigap carrier, there is no need to obtain a separate signature authorization for the Medigap carrier.

Question 72

The time limit for sending in Medicare claims is the end of the calendar year in which professional services were performed.

Question 73

The assignment on a patient with Medicare-Medicaid must always be accepted or Medicaid will not pick up the residual.

Question 74

A Medicare patient with an HMO does not need a supplemental insurance policy.

Question 75

Medicare transmits Medigap claims electronically for participating physicians when Medigap information is provided on the original Medicare claim.