Chapter 9

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

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

Social Security benefit rates

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

The original Medicare Plan

Medicare beneficiaries can select from how many main types of coverage plans?

Two

E/M services during a global period that are unrelated to the procedure can be billed with what modifier?

-24

How many Medigap plans are available?

10

Providers located in areas designated by Medicare as HPSAs are eligible for ________ bonus payments from Medicare.

10%

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

115 percent

In what year did Medicare stop paying for all consultation codes from the CPT evaluation and management, except for telehealth consultation G-codes?

2010

What is the percentage of beneficiaries who are in the Original Medicare Plan?

30%

Medicare Physician Fee Schedule amounts are ________ higher than for nonparticipating providers.

5%

ABN is the abbreviation for

Advance Beneficiary Notice

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

Who has the right to appeal denied Medicare claims?

Both patients and providers have the right to appeal denied Medicare claims.

All laboratory work paid for by Medicare is regulated by

CLIA rules

CLIA is administered by

CMS

Medicare requires the use of which coding set for procedures and services?

CPT/HCPCS

What is the abbreviation CCI for?

Correct Coding Initiative

Telehealth consultations should be assigned a code from which section for Medicare beneficiaries?

HCPCS G-codes

A program that provides incentives for physicians for reporting on quality of care performance measures is called

Quality Payment Program.

The Medical Review program focuses on

Inappropriate billing

IPPE is the abbreviation for:

Initial Preventative Physical Examination

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 over age 65.

CLIA is a federal law that established standards for

Laboratory testing

LCD is the abbreviation for:

Local Coverage Determination

What is the legislation that redesigned the Medicare Part B reimbursement incentive and mandated the transition to the Medicare Beneficiary Identifier?

MACRA(Medicare Access and CHIP Reauthorization Act)

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

MSN

MAO is the abbreviation for

Medicare Advantage Organization

What is the collection of online articles that explain all Medicare topics?

Medicare Learning Network (MLN) Matters

MMA is the abbreviation for

Medicare Modernization Act

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

Which part of Medicare is also called Hospital Insurance

Medicare Part A

Medicare benefits are available to individuals in how many beneficiary categories?

Six

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

Which part of Medicare covers influenza, pneumococcal polysaccharide vaccine, and hepatitis B virus vaccinations?

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

What does the abbreviation MSA stand for in the Medicare program?

Medicare Savings account

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

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

Medicare beneficiaries

What does CCP stand for?

Medicare coordinated care plans

Roster billing is used to file simplified claims for certain

Medicare immunization programs

NCD is the abbreviation for:

National Coverage Determination

Medicare may classify conditions that are not covered as

Not medically Necessary

What does the abbreviation OIG stand for?

Office of Inspector General

How many preventive physical exams does Medicare cover?

One Initially

The Medicare fee-for-service plan, referred to by Medicare as the ________, allows the beneficiary to choose any licensed physician certified by Medicare.+ Choice?

Original Medicare Plan

Which of the following statements is true?

PAR providers can bill both Medicare and non-Medicare patients for missed appointments.

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

Paying a premium

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.

CLIA is the abbreviation for?

clinical lab improvement act

LCDs are:

coverage decisions that help providers determine medical necessity under Medicare

The medicare program

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 and eligible for Medicare Part B

CMS accepts only signatures that are

handwritten, electronic, facsimiles of original, and written/electronic signatures

Which of the following is considered the best defense under the Medicare Integrity Program?

having a strong compliance plan

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

Each Medicare enrollee receives a ________ issued by CMS

medicare card

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

medigap

The limiting charge under the Medicare program can be billed by

nonparticipating providers only

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

physician assistants and nurse-practitioners.

Under the Medicare global surgical package

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

What is performed for a patient who does not have symptoms, abnormal findings, or any past history of the disease?

screening service

The deductible for Medicare Part B is

set each year

How many CMS regional offices are there?

ten

Paper claims cannot be paid before what day after receipt of the claim?

the 29th day

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

the approved charge on the nonPAR fee schedule.

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

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 as not reasonable but there is no signed ABN.

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.

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.

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 year of service

Urgently needed care is defined in the Medicare program as

An unexpected Illness OR injury that requires immediate treatment

A Medigap plan is

an insurance offered by private insurance


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