Medical insurance

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

Under the Medicare program a non-practicing physician may not Bill more than 115% of

The approved charge on the non par fee schedule

The GY is appended to procedure codes for non-covered Medicare Services when

The item is excluded and the ABN is not required.

The modifier GA is appended to procedure codes for non-covered Medicare Services when?

The item is expected to be denied But there is a signed ABN.

The modifier GZ is appended to procedure codes for non-covered Medicare Services when

The item is expected to be denied as not reasonable, but there is no sign ABN.

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

The original Medicare Plan

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

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

Under the Medicare program if the approved amount for a procedure is $100. The practicing physician will be paid $100 by Medicare and the patient the nonparticipant Who accepts assessment will be paid?

$95

E / M Services during a global. That are unrelated to procedures that can be billed with what modifier.

-24

How many Medigap plans are there?

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 non par fee schedule is the limiting charge?

115 %

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

2

The coin share for Medicare Part B is

20%

In what year did Medicare stop paying for all consultation codes? For the CPT evaluation and management except for Telehealth consultation G Codes

2010

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

29th day

What is the percentage of beneficiaries Who are in the original Medicare Plan?

30%

Medicare physician fee schedule amount are ___________ higher than for non-participating providers

5%

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

6

What is the abbreviation for annual Wellness visit?

AWV

Physicians who participate in the Medicare program must:

Accept assignment and file claims for beneficiary

ABN is the abbreviation for

Advance Beneficiary Notice

If Medicare par physician thinks that a plan procedure will not be found the medically necessary by Medicare and so will not be reimbursed, The patient should be asked to sign a

Advance beneficiary notice

Who has the right to appeal Denied Medicare claims

Both patient 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 coding set for procedures and services

CPT - HCPCS

CLIA is the abbreviation for

Clinical Laboratory Improvement Amendments

CWF is the abbreviation for

Common Working File

What is the abbreviation CCI for?

Correct Coding Initiative

___________ Adults may be eligible for Medicare benefits.

Disabled

A screening service is defined as one that is.

Done to discover if the patient has an underdiagnose disease.

Medicare Program

Employees in 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.

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

Having a strong compliance plan.

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

Hcpcs G Codes

HPSA is the abbreviation for:

Health Professional Shortage Area

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

Highest

A program that provides incentives for Physicians for reporting on quality of care performance measured is called.

Quality payment program

The medical review program focuses on

Inappropriate billing

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

Incident to rules

IPPE is the abbreviation for:

Initial Preventative Physical Examination

What's of the following statement 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

What's of the following is excluded from Medicare coverage?

Routine Dental examinations

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

Screening service

CLIA is a federal law that established standards for?

Laboratory Testing

LCD is the abbreviation for

Local Coverage Determination

What is the legislation that re-signed the Medicare Part B reimbursement incentive and mandated the transition to the Medicare beneficiary identifier

MACRA

________________ Are paid to process claims for government medical insurance programs?

MACs

Medicare beneficiaries receive a _______________ What is an explanation of Medicare benefits?

MSN

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

Medical savings account

Mao is the abbreviation for

Medicare Advantage Organization

What is the correct of online articles that explains all Medicare topics?

Medicare Learning Network MLN matters

MMA is the abbreviation for

Medicare Modernization Act

Home Health Care is covered under

Medicare Part A

Hospital benefits are provided under:

Medicare Part A

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 any individual receiving benefits under Medicare part

Medicare Part B

Watch Medicare Part provides coverage for durable medical equipment

Medicare Part B

What's part of Medicare covers influenza, pneumococcal polysaccharide vaccine, and hep. B virus vaccinations?

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

What part of Medicare was originally called Medicare + choice?

Medicare Part C

What Medicare Part offers a voluntary prescription drug plan that supplements Medicare benefits?

Medicare Part D

Medicare Administration contracts MACs processes Medicare claims for which of the following

Medicare beneficiaries

Each Medicare and rolly received a ________ issued by the CMS

Medicare card

What does CCP stand for?

Medicare coordinated care plans

Roster billing is used to file simplified claims for certain.

Medicare immunization programs

Care in skilled nursing facilities is covered under

Medicare part A

Hosparus care is covered under

Medicare part A

Which part of Medicare is also called Hospital insurance?

Medicare part A

Patients who received a _______________ that details the services they were provided over a 30-day period, the amounts charged, and the amounts. They may be billed.

Medicare summary notice

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

Medigap

NCD is the abbreviation for

National Coverage Determination

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

Non-participating providers only

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 physician 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?

Original Medicare Plan

What's 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.

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

Physician assistant and nurse practitioner

Which of the following statements is correct?

Physicians who do not participate in Medicare may decide whether to accept assessment on a claim by claim basis.

All of the following are non-covered items under Medicare except?

Ultrasound screening for abdominal aortic aneurysm

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

Waived test

Which of the following is excluded under Medicare?

cosmetic surgery

LCDs are:

coverage decisions that help providers determine medical necessity under Medicare

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 under Medicare?

routine medical appliances.

The deductible for Medicare Part B is

set each year

How many CMS regional offices are there?

ten

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

CMS success only signatures that are

All of these are correct.

Which of the following plans is offered by Medicare Advantage?

All of these are correct.

A Medigap plan is

An insurance offered by private insurance

Urgently needed care is defined and Medicare program as

An unexpected illness or injury that requires immediate treatment.

Under the Affordable Care Act, when must Medicare Part B providers file their claims.

Within one calendar year after the date of service.


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