Medical insurance
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.
