9-10

Medicare Part B beneficiaries pay a monthly premium that is calculated based on which of the following?

Social Security benefit rates

What does the abbreviation SSI stand for?

Supplemental Security Income

Patients with end-stage renal disease are entitled to Medicare benefits until:

They can be any age as long as they receive dialysis

If people receive employment income, what is the effect on eligibility for Medicaid?

They may qualify, depending on the income amount

Physicians who contract with Medicaid to provide services may not

-bill for services that are not medically necessary -submit claims for individual procedures that are part of a global procedure -bill for services not provided

Which of the following plans is offered by Medicare Advantage?

-medicare private fee for service plans -medicare coordinated care plans -medicare savings account

The coinsurance for Medicare Part B is:

20%

Medicare Part A is administered by:

CMS

Medicare Part B is administered by:

CMS

Medicare requires the use of which coding set for services?

CPT/HCPCS

CHIP is the abbreviation for

Children's Health Insurance Program

EPSDT is the abbreviation for

Early and Periodic Screening, Diagnosis, and Treatment

EMEVS stands for:

Electronic Medicaid Eligibility Verification System

Medicaid claims are usually submitted using the _________claim.

HIPAA837P

Which of the following statements is true?

Retired federal employees who are enrolled in the Civil Service Retirement System are eligible for Medicare benefits, as are their spouses

Which of the following statements is true?

Medicaid plans do not pay for a particular service if Medicare does not

Medicare Administrative Contractors (MACs) process Medicare claims for which of the following?

Medicare Beneficiaries

Which part of Medicare is also called Hospital Insurance?

Medicare Part A

Roster billing is used to file simplified claims for certain:

Medicare immunization programs

Incident-to-services and supplies are performed or provided by:

Physician assistants and nurses

Which of the following statements is correct?

Physicians who do not participate in Medicare may decide whether to accept assignment on a claim-by-claim basis.

The ________________established the Temporary Assistance for Needy Families program.

Welfare Reform Act

Individuals who are eligible for both Medicaid and Medicare benefits are called

both dual-eligibles and Medi-Medi beneficiaries

Anyone over age 65 who receives Social Security benefits is automatically

both enrolled in Medicare Part A and eligible for Medicare Part B

Medicaid beneficiaries must meet

both minimum federal requirements as well as any additional state requirements

Who has the rights to appeal denied claims?

both patients and providers have the right to appeal denied Medicare claims

Individuals receiving financial assistance under TANF due to low incomes and few resources must be covered

by state Medicaid programs

Which of the following is NOT offered under the Medicaid program?

comprehensive health insurance coverage, cosmetic procedures, and free prescriptions are offered to pregnant women whose family income is below 133 percent of the poverty level.

Claims billed to Medicare which are automatically sent to Medicaid are called

crossover claims

___________ adults may be eligible for Medicare benefits.

disabled

The medical insurance specialist should check patients' Medicaid eligibility:

each time an appointment is made

The Temporary Assistance for Needy Families provides which of the following?

financial assistance to beneficiaries

The Medical Review program focuses on:

inappropriate billing

Categorically needy people in the Medicaid program usually have

low incomes

Most states have moved Medicaid beneficiaries into which type of plan?

managed care plans

Restricted status refers to a category of:

medicaid beneficiary

The Medicare health insurance claim number is assigned to a:

medicare enrolle

Care in a skilled nursing facility is covered under:

medicare part a

Hospice care is covered under:

medicare part a

Outpatient hospital benefits are provided under:

medicare part b

Supplemental insurance plans for Medicare beneficiaries provide additional coverage for an individual receiving benefits under which Medicare Part?

medicare part b

Which Medicare Part provides coverage for durable medical equipment?

medicare part b

Which of the following is also called Supplemental Medical Insurance?

medicare part b

Medicare Advantage is under which part of Medicare?

medicare part c

Which Medicare Part offers a prescription drug plan?

medicare part d

Patients receive a _________________________ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed.

medicare summary notice

The limiting charge under the Medicare program can be billed by:

nonparticipating providers only

A person eligible for Medicaid in a given state is

not necessarily eligible in all other states

How many preventive physical exams does Medicare cover?

one initially

In a spend down program, beneficiaries are required to:

pay part of their monthly expenses

Medicaid is known as the _____________________, since it is always billed after another plan has been billed, if other coverage exists.

payer of last resort

People who are over age 65 but who are not eligible for free Part A coverage may enroll by

paying a premium

States must cover all of the following to receive federal funding, except:

prescription drugs

Which of the following is excluded from Medicare coverage?

routine dental examinations

A Medi-Medi beneficiary's claim information is usually:

sent by Medicare to Medicaid as the secondary payer

The deductible for Medicare Part A is:

set each year

The deductible for Medicare Part B is:

set each year

Each Medicare enrollee receives a Medicare card issued by:

social security administration

The State Children's Health Insurance Program includes all of the following except:

sports physicals

Providers in capitated managed care plans who are paid flat monthly fees:

still must file claims with the Medicaid payer

Under the Medicare program, a nonparticipating physician may not bill more than 115 percent of:

the approved charge on the nonPAR fee schedule

FMAP is the basis for federal government Medicaid allocations to

the states

Which of the following is true about Medicaid-participating providers?

they can bill the patient for excluded services if certain conditions are met

Most Medicare claims are HIPAA 837P transactions and are:

transmitted electronically

State Medicaid programs must provide coverage for all of the following except:

vision benefits

Under the Affordable Care Act, when must Medicare Part B providers file their claims?

within one calendar year after the date of service

A Medigap plan is:

an insurance offered by private insurance

Physicians who participate in the Medicare program must:

accept assignment and file claims for beneficiaries

ABN is the abbreviation for:

advance beneficiary notification

Which of the following assets must be taken into account to determine Medicaid eligibility?

all of these things must be considered