MIT 104: CH9 Test Your Understanding
E/M services during a global period that are unrelated to the procedure can be billed with what modifier?
*-59* -25
The Medicare program
*directly pays the claims* directly pays the Medicare beneficiary
How many Medigap plans are available?
10
The coinsurance for Medicare Part B is
20 percent
ABN is the abbreviation for
Advance Beneficiary Notice
All laboratory work paid for by Medicare is regulated by
CLIA rules
CLIA is administered by
CMS
CLIA is the abbreviation for
Clinical Laboratory Improvement Amendments
CWF is the abbreviation for
Common Working File
HPSA is the abbreviation for
Health Professional Shortage Area
A program that provides incentives for physicians for reporting on quality of care performance measures is called
Quality Payment Program
IPPE is the abbreviation for
Initial Preventative Physical Examination
Care in a skilled nursing facility is covered under
Medicare Part A
Home health care is covered under
Medicare Part A
Hospice care is covered under
Medicare Part A
Hospital benefits are provided 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
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
Roster billing is used to file simplified claims for certain
Medicare immunization programs
NCD is the abbreviation for
National Coverage Determination
A screening service is defined as one that is
done to discover if a patient has an undiagnosed disease
Anyone over age 65 who receives Social Security benefits is automatically
enrolled in Medicare Part A and eligible for Medicare Part B
CMS accepts only signatures that are
handwritten, electronic, facsimiles of original, and 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
CLIA is a federal law that established standards for
laboratory testing
Each Medicare enrollee receives a __________ issued by CMS.
medicare card
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
The deductible for Medicare Part B is
set each year
Medicare benefits are available to individuals in how many beneficiary categories?
six
How many CMS regional offices are there?
ten
Paper claims cannot be paid before what day after receipt of the claim?
the 29th day
Medigap insurance plans can be purchased as a supplement for individuals enrolled in
the Original Medicare Plan
Under the Medicare program, a nonparticipating physician may not bill more than 115 percent of
the approved charge on the nonPAR fee schedule
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
All of the following are noncovered items under Medicare except
ultrasound screening for abdominal aortic aneurysms
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
A Medigap plan is
an insurance offered by private insurance