Chapter 14 - Quiz

The patient has the following healthcare plan: Medicare, Medigap, and an employer large group health plan (EGHP). The billing order for this patient would be: a. EGHP, Medicare, Medigap b. Medigap, Medicare, EGHP c. Medicare, Medigap, EGHP d. Medicare, EGHP, Medigap

EGHP, Medicare, Medigap

Which Medicare plans provide care under contract to Medicare (in the form of managed care plans and private fee-for-service plans) and may include benefits such as prescription drugs and reductions in out of pocket expenses a. Medicare Advantage b. Medicare Part B c. Medicare Part D d. Medicare Savings Account

a. Medicare Advantage

An agreement between a Medicare beneficiary and a physician or other practitioner who has "opted out" of Medicare for two years is known are: a. a Medicare private contract b. a participating provider agreement c. accepting assignment d. assignment of benefits

a. Medicare private contract ...

Individual automatically enrolled in Medicare Part A are those who: a. already receive Social Security, Railroad Retirement Board, or disability benefits and are not yet age 65 b. qualify for both Part A and Part B c. have an annual income that falls below the federal poverty level d. turn age 65 of age as of March 1 of any given year

a. already receive Social Security, Railroad Retirement Board, or disability benefits and are not yet age 65f

Prior to performing an elective procedure or a noncovered procedure on a Medicare beneficiary, a nonPAR must do what? a. Collect a deposit toward the cost of the procedure b. Have the beneficiary sign and date a surgical disclosure notice c. Have the patient sign a waiver of liability form d. Obtain a copy of the beneficiary's living will

b. Have the beneficiary sign and date a surgical disclosure notice

Under which program does the federal government require state Medicaid program to pay Medicare B premiums, patient deductibles, and coinsurance for individuals who have Medicare Part A, a low monthly income, limited resources and are not otherwise eligible for Medicaid a. Qualified Disabled Working Individual b. Qualified Medicare Beneficiary c. Qualifying Individual d. Special Low Income Medicare Beneficiary

b. Qualified Medicare Beneficiary

The act of billing the patient for the difference between the charged fee and the Medicare allowed fee (which is restricted in many states) is known as a. accepting assignment b. balance billing c. collecting coinsurance d. roster billing

b. balance billing

Which type of account provides a means for individuals without Medicare to set aside money for current medical expenses as well as future medical expenses, with the benefit of tax-favored treatment of the funds? a. extra coverage plan b. health savings account c. Medicare saving account d. Program of All-Inclusive Care for the Elderly

b. health savings account

The general enrollment period for Medicare Part B coverage: a. begins on the beneficiary's birthday and continues for a period of 90 days b. is held from January 1 through March 31 each year c. is open which means eligible individuals can enroll at any time d. is the same a that for the initial enrollment period.

b. is held from January 1 through March 31 each year

Medicare is available to an individual who has worked at least: a. 5 years in Medicare-covered employment, is at least 65 years old, and is a permanent resident of the United States b. 10 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the United States c. 10 years in Medicare-covered employment, is at least 65 years old, and is a citizen or permanent resident of the United States d. 25 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the United States

c. 10 years in Medicare-covered employment, is at least 65 years old, and is a citizen or permanent resident of the United States

Upon applying for Medicare Part A and Part B, an initial enrollment period of _____ months begins. a. 3 b. 6 c. 7 d. 12

c. 7

Medicare Advantage plans, also called Medicare Part __, include managed care plans and private fee-for-service plans that provide care under contract to Medicare and may include such benefits as coordination of care, reductions in out of pocket expenses, and prescription drugs a. A b. B c. C d. D

c. C

The Privacy Act of 1974 allows MACs to release unassigned claim status information to nonPARs, as follows: a. amount paid on the claim and approved charge information b. date the claim was paid by the MAC and approved charge information c. date the claim was received by the MAC; date the claim was paid, denied, or suspended; and general reason the claim was suspended d. date the claim was received by the MAC; date the claim was paid, denied, or suspended; and the amount paid on the claim

c. date the claim was received by the MAC; date the claim was paid, denied, or suspended; and general reason the claim was suspended

Hospice provides which services for patients: a. Medical care in the home with the goal of keeping the patient out of the acute or long-term care setting b. Medical care, as well as psychological, sociological, and spiritual care c. no copy if the patient has had a three day minimum qualifying stay in an acute care facility d. temporary hospitalization for a terminally ill, dependent patient for the purpose of providing relief from duty for the nonpaid caregiver of that patient

c. no pay if the patient has had a three day minimum qualifying stay in an acute care facility

The limiting charge is the maximum fee a nonPAR may charge for a covered service. If the Medicare allowed fee for a service is $100, the nonPAR limiting charge would be: a. $76 b. $80 c. $95 d. $115

d. $115. 15 percent over the nonPAR approval

Medicare Supplementary Insurance is also known as: a. Medicaid b. Medicare Advantage c. Medicare SELECT d. Medigap

d. Medigap

Lifetime reserve days: a. accrue each year, until Medicare beneficiary has earned 90 days, which can then be used as needed b. include a total of 60 days that are to be used all at once, on a continuous basis, by the Medicare patient c. may be used only once during a patient's lifetime and are usually used during the patient's final, terminal hospital stay d. renew on January 1 of each year for each Medicare patient, and can be used by the beneficiary as needed.

d. may be used only once during a patient's lifetime and are usually used during the patient's final, terminal hospital stay

Which of the following providers are required to accept assignment on all Medicare covered services, regardless of their participating status? a. anesthesiologist b. ophthalmologists c. psychiatrists d. psychologists

d. psychologists

A Medicare private contract is an agreement between the Medicare beneficiary and a physician who has "opted out" of Medicare for two years. This means that a. claims submitted to Medicare will be processed along with claims submitted to supplemental insurance claims (Medigap) b. Medicare payments will be made for services and procedures provided to patients c. the patient is not required to pay physician charges, and the physician is not limited as to charges submitted to Medicare d. the physician cannot bill for any service or supplies provided to any Medicare beneficiary for at least two years.

d. the physician cannot bill for any service or supplies provided to any Medicare beneficiary for at least two years

A Medicare benefit period begins: a. after the Medicare patient's spell of illness has ended but before any subsequent inpatient hospitalizations b. each time a Medicare patient is admitted tot he hospital, regardless of the number of days the patient has been out of the hospital c. just once each year, on January 1, whether or not the patient is admitted to the hospital d. with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days

d. with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days