Cloned from: HIT 9 (6/4)



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Medicare was established by Congress in 1966 to provide financial assistance with medical expenses to:   a. People older than 65 b. People with ESRD c. People younger than 65 with disabilities d. All of the above  
a. People older than 65  
Medicare requires its beneficiaries to pay premiums, deductibles, and coinsurance, which is referred to as:   a. Medigap b. Taxation c. Cost sharing d. Allowable charges
c. Cost sharing  
Medicare Part A, the hospital insurance part of Medicare, is funded through:   a. Taxes withheld from employees' wages b. Taxes paid by employers c. State funds d. a and b are correct
d. a and b are correct
Part A coverage is available free of charge to eligible Medicare beneficiaries who:   a. Have no other insurance b. Are "dual eligibles" c. Are eligible to receive Social Security benefits d. Medicare Part A is not free of charge to anyone
c. Are eligible to receive Social Security benefits  
A private organization that contracts with Medicare to pay Part A and some Part B bills and determines payment to Part A facilities is called a:   a. Fiscal intermediary (FI) b. Part A negotiator c. Beneficiary d. PAR provider
a. Fiscal intermediary (FI)  
Medicare Part B helps pay for:   a. Medically necessary physician's services b. Acute care hospitilization c. Custodial and long-term care d. All of the above
a. Medically necessary physician's services  
Medicare pays ______% of allowable charges after the annual deductible is met.   a. 20 b. 50 c. 80 d. 100
c. 80  
The ________ is the duration of time during which a Medicare beneficiary is eligible for Part A benefits for services incurred in a hospital and/or skilled nursing facility (SNF).   a. Donut hole b. Medicare gap c. Benefit period d. Open enrollment period
c. Benefit period  
Managed healthcare plans that offer regular Part A and Part B Medicare coverage and additional coverage for certain other services is called:   a. Medicare Part A b. Medicare Part B c. Medicare Part C d. Medicare Part D
c. Medicare Part C
Coverage requirements under Medicare state that for a service to be covered, it must be considered:   a. Proper and timely b. Reasonable and customary c. Medically necessary d. Medicare has no coverage requirements
c. Medically necessary  
The prescription drug coverage plan, which began in January 2006, is called:   a. Medicare Part A b. Medicare Part B c. Medicare Part C d. Medicare Part D
d. Medicare Part D
In Medicare Part D, once the initial coverage limit is reached, beneficiaries are subject to another deductible, known officially as the "Coverage Gap" or more commonly as the _______, in which they must pay the full cost of medicine.   a. Medigap b. Donut hole C. Crosswalk d. Nonbenefit period
b. Donut hole
An individual qualifying for Medicare and Medicaid benefits is referred to as a:   a. Dual eligible b. MediMax c. Medical qualifier d. Categorically eligible
a. Dual eligible  
The program that provides community-based acute and long-term case services to Medicare beneficiaries is called:   a. FICA b. PACE c. CLIA d. LMRP
b. PACE  
A health insurance plan sold by private insurance companies to help pay for healthcare expenses not covered by Medicare is called a:   a. Commercial policy b. Trading partner plan c. Prospective payment plan d. Supplemental policy
d. Supplemental policy
The term used when another insurance policy is primary to Medicare is:   a. Medigap b. Medicare Supplement insurance c. Medicare Secondary Payer d. Other health insurance (OHI)
c. Medicare Secondary Payer  
Some Medicare HMO enrollees are allowed to see specialists outside the "network" without going through a PCI. This is called:   a. Self-referring b. Open enrollment c. Noncovered services D. Not medically necessary
a. Self-referring  
A group of medical providers that skips the insurance company middleman and contracts directly with patients is referred to as a:   a. Coordination of benefits b. Non-PAR provider c. Trading partner agreement d. Provider-sponsored organization
d. Provider-sponsored organization
LMRPs were replaced in 2003 by:   a. CLIAs b. LCDs c. COBs d. QIOs  
b. LCDs  
A form that Medicare requires all healthcare providers to use when Medicare does not pay for a service is the:   a. SPRA b. COB c. ABN d. EOB
c. ABN  
Exceptions to mandantory electronic claims filing include   a. claims with paper attachment(s) b. demand bills c. claims when Medicare is the secondary payer d. all of the above
d.all of the above 
Medicare "initial claims" do not include   a. adjustments b. Medi/Medi claims c. appeal requests d. previously submitted claims
b. Medi/Medi claims
The deadline for submitting Medicare claims is   a. 90 days from the date(s) of service b. October first of the year following the date(s) of service c. on or before December 31 of the calendar year following the date(s) of service d. December 1 of the year in which services were rendered
c. on or before December 31 of the calendar year following the date(s) of service  
There are ____ levels of the Medicare appeals process.   a. 4 b. 5 c. 6 d. 7
b. 5  
The acronym for the quality reporting system that provided an incentive payment for eligible professionals (EPs) who satisfactorily reported data on quality measures for covered services furnished to Medicare beneficiaries is   a. PQRI b. CLIA c. LMRP d. FICA
a. PQRI  
True or False?   Medicare Parts A and B are provided free of chage for qualifying individuals.
False
True or False?   Part A covers custodial and long-term care.
False
True or False?   Neither Medicare Part A nor Part B covers any preventitive care services.
False
True or False?   For durable medical equipment (DME) to qualify for Medicare payment, it must be ordered by a physician for use in the home and items must be reusable.
True
True or False?   Most Medicare Part B beneficiaries pay for Part B coverage in the form of a premium deducted from their monthly Social Security check.
True
True or False?   Medicare beneficiaries are allowed only one "benefit period" per year.
False
True or False?   An individual must be eligible for Part A or B to enroll in Medicare Advantage Plan.
True
True or False?   If a beneficiary has a Medicare Advantage Plan, he or she still needs a supplemental policy.
False
True or False?   An individual who has Medicare Parts A and B must have a supplemental policy.
False
True or False?   The private organization that determines payment of Part B covered items and services is called a peer review organization (PRO).  
False
True or False?   If individuals do not sign up for Medicare Part B when first becoming eligible and later decide to enroll, the monthly premiums may be higher due to penalties.  
True
True or False?   When an individual turns 65 and enrolls in Medicare, federal law forbids insurance companies from denying eligibility for Medigap policies for 6 months.
True
True or False?   Workers' compensation would likely be a primary payer to Medicare.
True
True or False?   Medicare HMOs typically screen potential enrollees for preexisting conditions.
False
True or False?   Under certain circumstances, a signed release of information form for Medicare beneficiaries can be valid for more than 1 year.
True
True or False?   Medicare's definition of medical necessity must meet specific criteria.
True
True or False?   Medicare HICNs are typically in the format of nine numeric characters followed by one alpha character.
True
True or False?   The Medicare fee schedule is now based on a resource-based relative value system.
True
True or False?   Medicare nonPARs do not have to submit claims for their Medicare patients.
False
True or False?   The process of matching one set of data elements or category of codes to their rquivalents within a new set of elements or codes is called a crossover.
False
The program that provides community-based acute and long-term care services.
PACE (Programs for All-Inclusive Care for the Elderly)
A health insurance plan sold by private insurance companies to help pay for expenses not covered by Medicare.
Medigap
The time period Medicare allows for enrolling in a Medicare supplement plan without penalty.
Open enrollment
The term used when Medicare is not the primary payer and the beneficiary is covered under another insurance policy.
MSP (Medicare Secondary Payer)
The individual responsible for initial MSP development activities formerly performed by Medicare FIs and carriers.
COB contractor (Coordination of Benefits)
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