MAI230 - Ch. 9 Review

Each Medicare enrollee receives a Medicare card issued by: Centers for Medicare & Medicaid Services Health & Human Services Office of the Inspector General Social Security Administration

Social Security Administration

Medicare Part B beneficiaries pay a monthly premium that is calculated based on which of the following? age income Social Security benefit rates part B does not have a monthly premium

Social Security benefit rates

If a paper claim and a HIPAA 837P claim are sent on the same day, which of the following is true? Multiple Choice The paper claim will be paid first. The HIPAA 837P claim will be paid first. Both claims will be denied. Both claims will be paid and the sender will be fined.

The HIPAA 837P claim will be paid first.

Patients with end-stage renal disease (ESRD) are entitled to Medicare benefits until they reach the age of 30. they reach the age of 65. after reaching the age of 65. They can be any age as long as they receive dialysis or a renal transplant.

They can be any age as long as they receive dialysis or a renal transplant.

What percentage of the fee on the Medicare nonPAR Fee Schedule is the limiting charge? 115 percent 100 percent 85 percent 80 percent

115%

The coinsurance for Medicare Part B is 10 percent. 20 percent. 30 percent. there is not a coinsurance.

20%

What is the abbreviation for annual wellness visit? AV AW AWV WV

AWV

ABN is the abbreviation for: Absolute Beneficiary Notice Advance Beneficiary Notice Annual Beneficiary Notice Applicable Beneficiary Notice

Advance Beneficiary Notice

Medicare Part A is administered by: CMS HIPAA Medicaid OIG

CMS

Medicare requires the use of which coding set for services? CPT HCPCS CPT/HCPCS ICD-10

CPT/HCPCS

CLIA is the abbreviation for: Coding Laboratory Improvement Amendments Clinical Laboratory Improvement Amendments Coding Laboratory Improvement Act Clinical Laboratory Improvement Act

Clinical Laboratory Improvement Amendments

CWF is the abbreviation for: Common Working File Case Working File Common Working Force Case Working Force

Common Working File

HPSA is the abbreviation for: Health Professional Shortage Area Health Persons Shortage Area Health Professional Staffing Agency Health Persons Staffing Agency

Health Professional Shortage Area

Which of the following statements is true? Retired federal employees who are enrolled in the Civil Service Retirement System are eligible for Medicare benefits, but their spouses are not. Retired federal employees who are enrolled in the Civil Service Retirement System are eligible for Medicare benefits, as are their spouses over age 65. Retired federal employees and their spouses who are enrolled in the Civil Service Retirement System are not eligible for Medicare benefits. Retired federal employees who are enrolled in the Civil Service Retirement System are not eligible for Medicare benefits.

Retired federal employees who are enrolled in the Civil Service Retirement System are eligible for Medicare benefits, as are their spouses over age 65.

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

MSN

Medicare Administrative Contractors (MACs) process Medicare claims for which of the following? Medicare Beneficiaries BCBS Policy holders Medigap holders None of these is correct

Medicare Beneficiaries

Each Medicare enrollee receives a _______________ issued by the Social Security Administration. Medicard Medicare card Medicare Benefit Card (MBC) Medicare Beneficiary Card (MBC)

Medicare Card

Home health care is covered under: Medicare Part A Medicare Part B Medicare Part C Medicare Part D

Medicare Part A

Hospice care is covered under: Medicare Part A Medicare Part B Medicare Part C Medicare Part D

Medicare Part A

Outpatient hospital benefits are provided under: Medicare Part A Medicare Part B Medicare Part C Medicare Part D

Medicare Part B

Which Medicare Part provides coverage for durable medical equipment? Medicare Part A Medicare Part B Medicare Part C Medicare Part D

Medicare Part B

Which of the following is also called Supplemental Medical Insurance? Medicare Part A Medicare Part B Medicare Part C Medicare Part D

Medicare Part B

Medicare Advantage is under which part of Medicare? Medicare Part A Medicare Part B Medicare Part C Medicare Part D

Medicare Part C

Which Medicare Part offers a prescription drug plan? Medicare Part A Medicare Part B Medicare Part C Medicare Part D

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 Statement Notice Medicare Notice Medicare Statement Medicare Summary Notice

Medicare Summary Notice

MMA is the abbreviation for: Medicare & Medicaid Modernization Act Medicaid Modernization Act Medicare Modernization Act Medical Modernization Act

Medicare modernization Act

Hospital benefits are provided under: Medicare Part A Medicare Part B Medicare Part C Medicare Part D

Medicare part A

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

Medigap

What does the abbreviation OIG stand for? Office of the Inspector General Office of the Internal General Office of the Investigative General Office of the Invasive General

Office of the Inspector General

The Medicare fee-for-service plan, referred to by Medicare as the ________________, allows the beneficiary to choose any licensed physician certified by Medicare. Old Medicare Plan Original Medicare Plan Former Medicare Plan Basic Medicare Plan

Original Medicare Plan

A program that provides incentives for physicians who log their patient care performance on predetermined health factors is called Advance Beneficiary Notice. False Claim Act Notice. Physician Quality Reporting Initiative. Notice of Exclusions from Medicare Benefits.

Physician Quality Reporting Initiative.

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. Physicians who participate in Medicare may decide whether to accept assignment on a claim-by-claim basis. Physicians will receive the same amount of reimbursement regardless if they participate in the Medicare program or not. Physicians must accept Medicare patients, per federal statute.

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 agree to accept the Medicare Fee Schedule charge amount as full payment for services. Physicians who do not participate in the Medicare program do not accept the Medicare Fee Schedule charge amount as full payment for services. Physicians will receive the same amount of reimbursement regardless if they participate in the Medicare program or not. Physicians must accept Medicare patients, per federal statute.

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

A Medigap plan is: an insurance offered by state governments an insurance offered by private insurance a part of Medicare to help supplement costs a part of Medicare that will pay for Medicare's monthly premiums

an insurance offered by private insurance

Who has the rights to appeal denied claims? patients have the right to appeal denied Medicare claims providers have the right to appeal denied Medicare claims both patients and providers have the right to appeal denied Medicare claims neither; a Medicare denied claim cannot be appealed

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

The Medicare program: directly pays the claims submitted by providers directly pays the Medicare beneficiary employs MACs to pay the claims submitted by providers employs MACs to pay the Medicare beneficiary

employs MACs to pay the claims submitted by providers

Anyone over age 65 who receives Social Security benefits is automatically enrolled in Medicare Part A. eligible for Medicare Part B. enrolled in Medicare Part A and eligible for Medicare Part B. neither enrolled in Medicare Part nor eligible for Medicare Part B.

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

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

highest

The Medical Review program focuses on: late billing inappropriate billing timeliness of billing credentials of biller

inappropriate billing

How many preventive physical exams does Medicare cover? one initially one annually one every two years this is not a covered exam

one initially

People who are over age 65 but who are not eligible for free Part A coverage may enroll by paying a deductible. paying a premium. paying into a Medical Savings Account. enrolling in a Medicare HMO.

paying a premium

Which of the following is excluded from Medicare coverage? glaucoma screening HIV testing routine dental examinations tobacco cessation counseling

routine dental examinations

The deductible for Medicare Part A is there is no deductible. set each year. based on the national debt. tied to the benefit period.

set each year

The deductible for Medicare Part B is: there is not a deductible set each year based on the national debt tied to the benefit period

set each year

Paper claims cannot be paid before what day after receipt of the claim? the 10th day the 29th day the 45th day the 60th day

the 29th day

Under the Medicare program, a nonparticipating physician may not bill more than 115 percent of: the Medicare approved amount from the MFS the approved charge on the nonPAR fee schedule either the Medicare approved amount from the MFS or the approved charge on the nonPAR fee schedule, whichever is lower neither the Medicare approved amount from the MFS nor the approved charge on the nonPAR fee schedule

the approved charge on the nonPAR fee schedule

The modifier GY is appended to procedure codes for noncovered Medicare services when: the item is expected to be denied but there is a signed ABN the item is expected to be denied as not reasonable but there is not a signed ABN the item is excluded and an ABN is not required the item is expected to be paid in full

the item is excluded and an ABN is not required

The modifier GZ is appended to procedure codes for noncovered Medicare services when the item is expected to be denied but there is a signed ABN. the item is expected to be denied as not reasonable but there is no signed ABN. the item is excluded and an ABN is not required. the item is expected to be paid in full.

the item is expected to be denied as not reasonable but there is no signed ABN.

Medigap insurance plans can be purchased as a supplement for individuals enrolled in: any type of Medicare plan all types of health insurance plans the Original Medicare Plan disability insurance

the original Medicare Plan

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

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

Most Medicare claims are HIPAA 837P transactions and are: transmitted electronically sent on paper claims never sent and deleted errors and kicked back to the biller

transmitted electronically

Under the Affordable Care Act, when must Medicare Part B providers file their claims? no later than the end of the calendar year following the year in which the service was furnished within one calendar year after the date of service no later than the end of the calendar year in the same year in which the service was furnished within six months after the date of service

within one calendar year after the date of service

Physicians who participate in the Medicare program must: accept assignment and file claims for beneficiaries file claims for beneficiaries accept assignment participating physicians do not have to do any of these

accept assignment and file claims for beneficiaries

Which of the following plans is offered by Medicare Advantage? Medicare private fee-for-service plans Medicare coordinated care plans (CCPs) Medicare Savings Accounts (MSAs) All of these answers are correct

all of these answers are correct

CMS accepts only signatures that are handwritten. electronic. facsimiles of original written/electronic signatures. all of these are correct.

all of these are correct