Ch.9 Exam

Each Medicare enrollee receives a Medicare card issued by:

Social Security Administration

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

They can be any age as long as they receive dialysis

What percentage of the fee on the Medicare NonPAR Fee Schedule is the limiting charge?

115 percent

The coinsurance for Medicare Part B is:

20%

Medicare Part A is administered by:

CMS

Medicare requires the use of which coding set for services?

CPT/HCPCS

What is the abbreviation CCI for?

Correct Coding Initiative

________ are paid to process claims for government medical insurance programs.

MACs

Medicare beneficiaries receive a(n)______________, which is an explanation of Medicare benefits.

MSN

Care in a skilled nursing facility is covered under:

Medicare Part A

Hospice care is covered under:

Medicare Part A

Hospital benefits are provided under:

Medicare Part A

Which part of Medicare is also called Hospital Insurance?

Medicare Part A

In cases when immunizations are covered, they are covered by which part of Medicare?

Medicare Part B

Outpatient hospital benefits are provided under:

Medicare Part B

Roster billing applies to which Part of Medicare?

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 part of Medicare was originally called Medicare + Choice?

Medicare Part C

Roster billing is used to file simplified claims for certain:

Medicare immunization programs

What is private insurance that beneficiaries may purchase to fill in some of the gaps—unpaid amounts—in Medicare coverage?

Medigap

What does the abbreviation OIG stand for?

Office of the Inspector General

A program that provides incentives for physicians who log their patient care performance on predetermined health factors is called

Physician Quality Reporting Initiative

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

Physician assistants and nurses

Which of the following statements is true?

Physicians may employ billing services to assign procedure and diagnosis codes for Medicare claims.

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.

Which of the following statements is true?

Physicians who do not participate in the Medicare program do not accept the Medicare Fee Schedule charge amount as full payment for services.

Anyone over age 65 who receives Social Security benefits is automatically

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

Who has the rights to appeal denied claims?

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

___________ adults may be eligible for Medicare benefits.

disabled

A screening service is defined as one that is:

done to discover if a patient has an undiagnosed disease

The Medicare program:

employs MACs to pay the claims submitted by providers

CMS accepts only signatures that are

handwritten electronic facsimiles of original written/electronic signatures

The Medicare limiting charge is the ____________ fee that can be charged for a procedure by a nonparticipating provider.

highest

Services supervised by the physician but provided by nonphysician practitioners are billed under

incident-to rules

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

nonparticipating providers only

Medicare may classify conditions that are not covered as:

not medically necessary

How many preventive physical exams does Medicare cover?

one initially

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

paying a premium

Under the Medicare global surgical package:

related pre- and postoperative visits cannot be billed in addition to the surgery

Which of the following is excluded from Medicare coverage?

routine dental examinations

Medigap insurance plans can be purchased as a supplement for individuals enrolled in:

the Original Medicare Plan

The modifier GA is appended to procedure codes for noncovered Medicare services when:

the item is expected to be denied but there is a signed ABN

A duplicate claim is defined as:

those sent to one or more Medicare contractors from the same provider for the same beneficiary, the same service and the same date of service

An easy to perform low-risk lab test that can be performed by CLIA in the physician's office is called a(n)

waived test

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

If a Medicare PAR physician thinks that a planned procedure will not be found medically necessary by Medicare and so will not be reimbursed, the patient should be asked to sign a(n)

advance beneficiary notice

ABN is the abbreviation for:

advance beneficiary notification