MEAS 137 Ch 9

What percentage of the fee on the Medicare nonPAR Fee Schedule is the limiting charge? A. 115% B. 100% C. 85% D. 80%

A. 115%

Medicare Part B is administered by: A. CMS B. HIPAA C. Medicaid D. OIG

A. CMS

CWF is abbreviation for: A. Common Working File B. Case Working File C. Common Working Force D. Case Working Force

A. Common Working File

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

A. Medicare Part A

The Medicare health insurance claim number is assigned to a: A. Medicare enrollee B. Participation Provider C. Participating Facility D. None of these are correct

A. Medicare enrollee

Roster billing is used to the simplified claims for certain: A. Medicare immunization programs B. Medicare providers C. Medicare beneficiaries who have Medigap D. Medicare screening programs

A. Medicare immunization programs

Medicare Part D covers: A. Prescription drugs B. Mammography C. Screening for cancer D. None of the above

A. Prescription drugs

The limiting charge under the medicare program can be billed by: A. nonparticipating providers only B. participating providers only C. either participating or nonparticipating providers D. neither participating or nonparticipating providers

A. nonparticipating providers only

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

A. one initially

What is performed for a patient who does not have symptoms, abnormal findings, or any past history of the disease? A. screening service B. surgical procedure C. referral service D. rehabilitation

A. screening service

Under the Medicare program, if the approved amount for a procedure is $100, the participating physician will be paid$100 (by Medicare and the patient), and the nonparticipant who accepts assignment will be paid: A. $115 B. $100 C. $95 D. $80

C. $95

In what year did Medicare stop paying for all consultation codes from the CPT evaluation and management, except for telehealth consultation G-codes? A. 2000 B. 2005 C. 2010 D. 2012

C. 2010

What is the percentage of beneficiaries that are in the Original Medicare Plan? A. 25% B. 50% C. 75% D. 90%

C. 75%

All laboratory work paid for by Medicare is regulated by: A. NPI rules B. HPSA rules C. CLIA rules D. NEMB rules

C. CLIA rules

Medicare requires the use of which coding set for services? A. CPT B. HCPCS C. CPT/HCPCS D. ICD-10

C. CPT/HCPCS

The Original Medicare Plan requires a premium, a deductible, and: A. Medigap. B. Supplemental insurance. C. Coinsurance. D. HIPAA TCS.

C. Coinsurance

Under Medicare's global surgical package regulations, a physician may bill separately for: A. Supplies used during the surgical procedure B. Procedures performed after the surgery to minimize pain C. Diagnostic tests required to determine the need for surgery D. The removal of tubes, sutures, or catheters

C. Diagnostic tests required to determine the need for surgery

Medicare Part A covers: A. Physician services. B. Prescription drugs. C. Hospital services. D. MACs.

C. Hospital services

MAO is the abbreviation for: A. Medicare Accounts Organization B. Medical Accounts Organization C. Medicare Advantage Organization

C. Medicare Advantage Organization

MMA is the abbreviation for: A. Medicare & Medicaid Modernization Act B. Medicaid Modernization Act C. Medicare Modernization Act D. Medical Modernization Act

C. Medicare Modernization Act

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

C. Physician Quality Reporting Initiative

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

C. the Original Medicare plan

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

B the HIPAA 837P claim will be paid first

Under the Medicare Part B traditional fee-for-service plan, Medicare pays ____________ percent of the allowed charges. A. 75 B. 80 C. 90 D. 100

B. 80

A Medigap plan is: A. An insurance offered by state governments B. An insurance offered by private insurance C. A part of Medicare to help supplement costs D. A part of Medicare that will pay for Medicare's monthly premiums

B. An insurance offered by private insurance

CLIA is the abbreviation for: A. Coding Laboratory Improvement Amendments B. Clinical Laboratory Improvement Amendments C. Coding Laboratory Improvement Act D. Clinical Laboratory Improvement Act

B. Clinical Laboratory Improvement Amendments

What is the abbreviation CCI for? A. Clinical Coding Initiative B. Correct Coding Initiative C. Clinical Coding Indicator D. Correct Coding Indicator

B. Correct Coding Intiative

Which modifier indicates that a signed ABN is on file? A. AB B. GA C. GZ D. GY

B. GA

Under Medicare Advantage, a PPO _________________ an HMO. A. Is more restrictive than B. Is less restrictive than C. Has the same network as D. Has the same deductible as

B. Is less restrictive than

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

B. Medicare Part B

Roster billing applies to which Part of Medicare? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D

B. Medicare Part B

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

B. Medicare Part B

Which part of Medicare is also called Supplementary Medical Insurance? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D

B. Medicare Part B

What does CCP stand for? A. coordinated care provider B. Medicare coordinated care plans C. coordinating care with providers D. Medicare coordinating care with providers

B. Medicare coordinated care plans

What is private insurance that beneficiaries may purchase to fill in some of the gaps--unpaid amounts--in Medicare coverage? A. Medifill B. Medigap C. Gapfill D. Medisupplement

B. Medigap

NCD is the abbreviation for: A. National coverage diagnosis list B. National coverage determination C. Nationally covered diagnoses D. Nationally covered doctors

B. National coverage determination

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

B. Original Medicare Plan

The deductible for Medicare Part A is: A. There is no deductible B Set each year C. Based on the national debt D. Tied to the benefit period

B. Set each year

Medicare medical review is conducted by: A. The physician B. The MAC C. The primary payer D. The ZPIC

B. The MAC

The Medical Review program focuses on: A. late billing B. inappropriate billing C. timeliness of billing D. credentials of biller

B. inappropriate billing

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

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

Medicare beneficiaries can select from how many main types of coverage plans? A. one B. two C. four D. there is no choice

B. two

Determine which of the following individuals is not eligible for coverage under Medicare without paying a premium. A. The husband of a retired CSRS employee B. A retired woman with ESRD C. An individual who has been receiving Social Security disability benefits for four years D. A seventy-year-old man who has paid FICA taxes for twenty calendar quarters

D. A seventy-year-old man who has paid FICA taxes for twenty calendar quarters

Which of the following plans is offered by Medicare Advantage? A. Medicare private fee-of-service plans B.Medicare coordinated care plans (CCPs) C. Medicare Saving Accounts (MSAs) D. All of these answers are correct

D. All of these answers are correct

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

D. Medicare Part D

On claims, CMS will not accept signatures that: A. Are handwritten B. Are electronic C. Use facsimiles of original written/electronic signatures D. Use signature stamps

D. Use signature stamps

CMS accepts only signatures that are: A. handwritten B. electronic C. facsimiles of original written/electronic signatures D. all of these are correct

D. all of these are correct

Under the Medicare global surgical package: A. all pre- and postoperative visits can be billed in addition to the surgery itself B. only the pre-operative visit can be billed in addition to the surgery itself C. only the post-operative visit can be billed in addition to the surgery itself D. related ore- and postoperative visits cannot be billed in addition to the surgery

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

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

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

All of the following are noncovered items under Medicare except: A. acupuncture B. custodial services C. long-term care D. ultrasound screening for abdominal aortic aneurysms

D. ultrasound screening for abdominal aortic aneurysms