Chapter 9
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