Chapter 9

How many Medigap plans are available?

10

Providers located in areas designated by Medicare as HPSAs are eligible for ________ bonus payments from Medicare.

10% (Providers located in Health Professional Shortage Areas (HPSAs) are eligible for 10 percent bonus payments from Medicare.)

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% (Medicare Physician Fee Schedule (MPFS) amounts are 5% higher than for nonparticipating (nonPAR) providers.)

All laboratory work paid for by Medicare is regulated by

CLIA rules. (All laboratory work paid for by Medicare is regulated by CLIA rules.)

________ adults may be eligible for Medicare benefits.

Disabled (Disabled adults may be eligible for Medicare benefits if they meet the requirements. They must have been receiving Social Security disability benefits or Railroad Retirement Board disability benefits for more than two years. Coverage begins five months after the two years of entitlement.)

A program that provides incentives for physicians for reporting on quality of care performance measures is called

Quality Payment Program. (A program that provides incentives for physicians for reporting on quality of care performance measures is called the Quality Payment Program.)

________ are paid to process claims for government medical insurance programs.

MACs (MACs are paid to process claims for government medical insurance programs.)

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

Medical Savings Account

What is the collection of online articles that explain all Medicare topics?

Medicare Learning Network (MLN) Matters

Home health care is covered under

Medicare Part A.

Roster billing applies to which Part of Medicare?

Medicare Part B

Which of the following is also called Supplemental Medical Insurance?

Medicare Part B

Which part of Medicare was originally called Medicare + Choice?

Medicare Part C

Medicare Administrative Contractors (MACs) process Medicare claims for which of the following?

Medicare beneficiaries

Each Medicare enrollee receives a ________ issued by CMS.

Medicare card

What does CCP stand for?

Medicare coordinated care plans

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

Medigap (Private insurance that beneficiaries may purchase to fill in some of the gaps in Medicare coverage is called Medigap.)

NCD is the abbreviation for

National coverage determination.

What does the abbreviation OIG stand for?

Office of the Inspector General (OIG is the abbreviation for Office of the Inspector General.)

Which of the following statements is true?

PAR providers can bill both Medicare and non-Medicare patients for missed appointments.

A Medigap plan is

an insurance offered by private insurance. (A Medigap insurance plan is an insurance offered by a private insurance carrier.)

The Medicare program

employs MACs to pay the claims submitted by providers. (The Medicare program employs MACs to pay the claims submitted by providers.)

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. (Services supervised by the physician but provided by nonphysician practitioners are billed under incident-to rules.)

LCD is the abbreviation for

local coverage determination. (LCD is the abbreviation for local coverage determination.)

The limiting charge under the Medicare program can be billed by

nonparticipating providers only.

How many preventive physical exams does Medicare cover?

one initially

Under the Medicare global surgical package

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

The deductible for Medicare Part B is

set each year. (The deductible for Medicare Part B is set annually.)

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

the Original Medicare Plan.

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 GY is appended to procedure codes for noncovered Medicare services when the item is excluded and an ABN is not required.)

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

two (Medicare beneficiaries can select from a traditional fee-for-service or managed care.)

All of the following are noncovered items under Medicare except

ultrasound screening for abdominal aortic aneurysms.

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

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

within one calendar year after the date of service (The Affordable Care Act requires Medicare Part B providers to file their claims within one calendar year after the date of service.)

Physicians who participate in the Medicare program must

accept assignment and file claims for beneficiaries. (Physicians who participate in the Medicare program must accept assignment and file claims for beneficiaries.)

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.