2305/ Wk 13/ Test 4

True

True or False? Part A & Part B are known as "Original Medicare"

NPI

10-digit numeric identifier that does not change and is required to enroll as a Medicare provider and supplier. (abbreviation)

b

A program through which organizations contract with CMS to provide coverage of health care services to Medicare beneficiaries. a) Medigap b) Medicare Advantage Plan c) Medicare Part D d) Medicaid

e

After submission, Medicare enrollment applications are processed by: a) Regional A/B Medicare Administrative Contractors (MACs) b) The National Supplier Clearinghouse c) Durable Medical Equipment Medicare Administrative Contractors (DME MACs) d) A and C e) A and B

d

As defined by law in the SSA, payment for Original Medicare services is contingent upon a determination that: a) a service meets a benefit category b) a service is not specifically excluded from coverage c) the item or service is reasonable and necessary d) all of the above

a

Beneficiaries are enrolled in the Medicare Program through: a) SSA b) CMS c) HHS d) PECOS

e

CMS's main functions are to a) make certain Medicare is administered properly b) establish policy for payment of providers c) conduct research d) assess the quality of health care facilities and services e) all of the above

b

Choose the best definition of Medicare: A. Medicare is a Federal health insurance program created by Congress for government workers and their spouses only. B. Medicare is a national health insurance program that provides hospital insurance, medical insurance, and a voluntary prescription drug benefit. C. The Medicare Program began in 1990 to establish health insurance for the poor and medically indigent. D. Only people age 65 or older are eligible for Medicare.

d

Choose the correct statement about Medigap: A. If a beneficiary drops their Medigap policy, they can get it back at any time. B. To be eligible for Medigap, beneficiaries need only be enrolled in Medicare Part A. C. Medigap policies currently sold include prescription drug coverage. D. Medigap helps pay some of the health care costs that the Original Medicare Plan doesn't cover.

a

Choose the sentence which correctly describes Medicare Advantage (MA) Plans: A.Beneficiaries must be entitled to Medicare Part A, enrolled in Part B, and live in the plan service area to be eligible to enroll in an MA Plan. B.MA Plans always include prescription drug coverage. C.Beneficiaries may enroll in MA Plans during anytime of the year. D.To enroll in an MA Plan, individuals need not be enrolled in Medicare Part B.

d

Choose the type of care that is NOT covered by Medicare Part B: a) doctor's services b) preventive services c) outpatient services d) inpatient hospital services

yes

Do MA plans generally have provider networks?

yes

Do many Medicare Advantage plans include prescription drug coverage as well as A & B benefits?

d

HPIAA covered entities include: a) health plans b) clearinghouses c) providers who electronically transmit information d) all of the above

yes

Is Part D voluntary?

f

Medicare A & B do NOT generally cover: a) acupuncture b) chiropractic services c) dental care d) eye care e) A & C f) all of the above

b

Medicare Advantage Plans provide benefits from which Parts of Medicare? a) A & C b) A & B c) just C d) B & C

b

Medicare Part A benefits include: A. Doctor services B. Inpatient hospital care C. Outpatient care D. Durable medical equipment

d

Medicare Part A covers: a) home health services b) hospice care c) preventive care d) A & B e) A, B, & C

c

Medicare Part A is also known as a) Supplemental Insurance b) Medical Insurance c) Hospital Insurance d) Long-Term Care Insurance

d

Medicare Part B covers: a) x-rays, lab tests, diagnostic tests b) ambulance services c) physician services, including surgery and consultation d) all of the above

d

Medicare Prescription Drug Plans must cover most drugs to treat certain conditions, including: a) cancer medications b) HIV/AIDS treatment c) antidepressants d) all of the above

d

Medicare covers a) Age 65 and over b) under 65 with certain disabilities c) any age with end-stage renal disease d) all of the above

c

Medicare provides coverage for all of the following individuals, except: A. People with certain disabilities who have been entitled to Social Security or Railroad Retirement Board benefits for 24 months B. People with End-Stage Renal Disease (ESRD) C. People without insurance who fall below the Federal poverty line D. People who are 65 or older

dual eligibles

People who qualify for both Medicare and Medicaid are called:

c

People with Medicare are called: a) enrollees b) patients c) beneficiaries d) doctors

d

Private supplemental policies that help pay some of the health care costs that the Original Medicare Plan doesn't cover. a) Donut hole b) Part B c) Part C d) Medigap

d

Providers that submit claims for Part B benefits a) physicians b) suppliers c) NPPs d) all of the above

b

Select the TRUE statement about Part D plan formularies. A. Formularies must include all Medicare Part D-covered drugs. B. A formulary is a list of drugs covered by a Medicare Prescription Drug Plan. C. All drugs on a plan's formulary always need prior authorization from the plan before they will be covered. D. Plans must notify beneficiaries 365 days in advance of formulary changes that affect a drug they take.

b

The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign providers unique identifiers called______ ________ ______. A. Identity & Access Management B. National Provider Identifiers C. Medicare Advantage Plans D. Provider Tagging System

d

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 created which part of Medicare? a) Part A b) Part B c) Part C d) Part D

b

The National Provider Identifier (NPI) is: a) A unique patient identifier b) Required to enroll as a Medicare provider or supplier c) A and B

b

The agency of HHS that oversees the Medicare program: a) CBO b) CMS c) HSA d) MCS

d

The combination of Medicare Part A and Part B is commonly referred to as _______________. A. Fee-For-Service B. Original Medicare C. Medicare Part C D. Both A and B

True

True or False? A Private Fee-For-Service (PFFS) Plan is a type of MA Plan in which beneficiaries may go to any Medicare-approved provider if the provider agrees to accept the plan's terms of payment before treating the beneficiary.

False

True or False? A beneficiary does not need to be enrolled in the Original Medicare Plan to purchase a Medigap policy.

True

True or False? A physician is an example of a provider that submits claims for Part B services.

False

True or False? All beneficiaries are automatically enrolled in a Medicare Prescription Drug Plan with a formulary when they become eligible for Medicare.

True

True or False? Anyone who is eligible for Part A and is enrolled in Part B and lives in a plan's service area is eligible to join the Part D plan.

True

True or False? Beneficiaries that join an MA plan usually do not need and cannot purchase a Medigap policy.

True

True or False? Coinsurance us the share of the cost for services that the beneficiary is responsible for after the deductible is met.

False

True or False? Drugs excluded by law, non-prescription drugs, and drugs that are covered under Part B are usually covered by Part D.

True

True or False? Generally, beneficiaries must have Medicare parts A & B to purchase a Medigap policy.

False

True or False? HIPAA covered entities are not required to have an NPI.

True

True or False? HIPAA mandated the adoption of NPI's to improve efficiency and effectiveness of electronic submission of medical information.

False

True or False? If you decide you want to be a participating Medicare provider, you can collect more than the deductible and coinsurance from the beneficiary if you feel the Medicare-allowed amount is too low.

True

True or False? Individuals under age 65 who have certain disabilities will automatically receive Part A after they receive disability benefits from the Social Security Administration (SSA) or Railroad Retirement Board (RRB) for 24 months.

True

True or False? Items and services that Medicare Parts A & B do not generally cover include cosmetic surgery, hearing aids, and long-term care.

False

True or False? MA Plans do not generally have provider networks. MA Plan members may use any provider for their health care services.

True

True or False? MA Plans offer extra benefits such as vision, hearing, dental, and/or health and wellness programs.

False

True or False? MA Plans provide Part A and Part B Medicare coverage, including hospice.

False

True or False? Many MA Plans do not include prescription drug coverage for no extra cost.

False

True or False? Medicare Administrative Contractor's (MAC) responsibilities include enrolling providers into Medicare Advantage (MA) Plans, processing Medicare claims, and assisting beneficiaries with the appeals process.

False

True or False? Medicare Advantage Plans are private insurance companies providing services under Medicare Part D.

True

True or False? Medicare Advantage Plans are private insurance plans that pay for some services that traditional Medicare does not.

False

True or False? Medicare Advantage is the same as Medigap/ Supplemental

True

True or False? Medicare Part A covers inpatient stays in Skilled Nursing Facilities and in Hospitals.

True

True or False? Medicare Prescription Drug Plan benefits can vary regarding which prescription drugs are covered, how much the beneficiary pays, and which pharmacies the beneficiary can use.

True

True or False? Medicare beneficiaries can receive their Medicare benefits, Part A & B, through the Original Medicare Plan or through a Medicare Advantage Plan.

True

True or False? Medigap only works with the Original Medicare Plan. They don't work with MA Plans.

True

True or False? Once users complete a profile in the Identity and Access Management System (I&A) they can access other systems such as Provider Enrollment, Chain and Ownership System (PECOS) and Electronic Health Records (EHR) Incentive Program.

True

True or False? Original Medicare is a FFS plan that includes Parts A & B.

False

True or False? People in the Original Medicare Plan can add prescription drug coverage by either joining a Medicare Prescription Drug Plan or selecting a Medigap policy that includes prescription drug coverage.

True

True or False? People often refer to the combination of Medicare Parts A & B as "Original Medicare" or "Fee-For-Service"

True

True or False? People with Medicare can obtain prescription drug coverage by either joining a Medicare Prescription Drug Plan or selecting an MA Plan that includes prescription drug coverage.

True

True or False? Providers and other health care professionals may enroll in the Medicare Program and also be selected as a provider in a Medicare Advantage (MA) Plan.

True

True or False? Providers and suppliers can apply for a National Provider Identifier (NPI) in one of the following three ways: electronic application, paper application, and electronic file interchange.

True

True or False? Providers must keep enrollment information up to date on all reportable events, including changes in location, ownership, banking arrangements, or final adverse actions.

True

True or False? Providers submitting claims for Part A benefits include, but are not limited to, hospitals, Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), and hospices.

True

True or False? The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) is a scenario driven application process.

True

True or False? The Medicare program serves the aged, certain disabled individuals, and individuals with ESRD.

True

True or False? The Original Medicare Plan includes Part A and Part B and is administered by Medicare Administrative Contractors (MACs).

False

True or False? The Railroad Retirement Board (RRB) oversees the entire Medicare Program.

False

True or False? The preferred method for enrolling as a Medicare provider is to mail in a paper enrollment form.

False

True or False? To accept Medicare payment, you do not have to enroll in Medicare.

National Provider Identifier

What does NPI stand for?

b

What year did Medicare add coverage for people with End-Stage Renal Disease (ESRD)? A. 1966 B. 1972 C. 1980

a

When Medicare was first established, what did it consist of? a) only Part A b) Part A and Part C c) only Part C d) none of the above

d

Which of the following are steps to becoming a Medicare provider? A. Getting a National Provider Identifier (NPI) B. Keeping your enrollment information up to date C. Entering your information into the Provider Enrollment, Chain and Ownership System (PECOS) D. All of the above

b

Which of the following is NOT a step involved in becoming a Medicare provider: A. Registering in the Identity and Access Management System (I&A) B. Requesting permission from State agencies C. Obtaining a National Provider Identifier (NPI) D. Entering enrollment information into the Provider Enrollment, Chain and Ownership System (PECOS)

d

Which of the following is a valid user type for the Identity and Access Management System (I&A)? A. Individual Provider B. Third Party Organization C. Delegated Official D. All of the above

b

Which of the parts of Medicare listed below is correct? A. Medicare Part A - Medicare Advantage Plans B. Medicare Part B - Medical Insurance C. Medicare Part C - Convalescent Care Plans D. Medicare Part D - Durable Medical Equipment Coverage

CMS

Who oversees the Medicare Program and a portion of the Medicaid Program?

d

Who should individuals contact to find out if they qualify for extra help paying for drug costs? a) HHS b) Congress c) CMS d) SSA