Medical Insurance billing ch 9
If a patient who lives in Texarkana, Arkansas, sees a physician for Medicare Part B services in Newark, New Jersey, to which location's MAC should the claim be sent?
The carrier for Newark, New Jersey
Under the Medicare Part B traditional fee-for-service plan, Medicare pays ______ percent of the allowed charges.
80
Medigap
A type of federally regulated insurance plan that provides coverage in addition to medicare part B
Urgently needed care
Emergency treatment needed by a managed care patient while traveling outside the plan's network area
Which modifier indicates that a signed ABN is on file?
GA
Hospice care is covered under
Medicare Part A
MAC
Medicare part A/ Part B administrator
not eligible for medicare coverage
Pregnant women, infants, immigrants, individuals 64 or younger, individuals with terminal cancer, individuals addicted to narcotics
fiscal intermediary
an organization that has a contract with Medicare to process insurance claims from physicians, providers, and suppliers
These gaps include the ______ any ______ and payment for some ______ services
annual deductible, coinsurance noncovered
The Original Medicare Plan requires a premium, a deductible, and
coinsurance
Even though private insurance carriers offer Medigap plans, ______ and standards are regulated by federal and state law.
coverage
Under Medicare's global surgical package regulations, a physician may bill separately for
diagnostic tests required to determine the need for surgery
CMS accepts only signatures that are
handwritten, electronic, facsimiles of original, and written/electronic signatures
Carrier
health plan
Medicare Part A covers
hospital services
eligible for medicare coverage
individuals age 65 and older, disabled adults, individuals disabled before age 18, spouses of entitled individuals, individuals with end stage renal disease, and retired federal employees enrolled in the civil service retirement system
Under Medicare Advantage, a PPO ______ an HMO
is less restrictive than
Medigap policyholders pay _____ premuims
monthly
______ _____ vary widely across different plan levels as well as within a single plan level, depending on the insurance plan selected
monthly premuims
Limiting charge
non participating physicians cannot charge more than 115 percent of the medicare fee schedule on unassigned claims
he limiting charge under the Medicare program can be billed by
nonparticipating providers only
Medicare Part D covers
prescription drugs
Medigap is private insurance that beneficiaries may____ to fill in some of the gaps - unpaid amounts in ____ coverage
purchase Medicare
The deductible for Medicare Part A is
set each year
The deductible for Medicare Part B is
set each year
Medicare medical review is conducted by
the MAC
On claims, CMS will not accept signatures that
use signature stamps
The details of gap plans change each _____, although they must cover certain basic _____.
year benefits
Medicare Summary Notice
a document furnished to medicare beneficiaries by the medicare program that lists the services they received and the payments the program made for them
advance beneficiary notice (ABN)
a form given to patients when the practice thinks that a service to be provided will not be considered medically necessary or reasonable by medicare
Medicare Advantage
a group of insurance plans offered under medicare part B intended to provide beneficiaries with a wider selection of plans
Provider Quality Reporting System (PQRS)
a program that provides a potential bonus for performance on selected measures addressing quality of care
Determine which of the following individuals is not eligible for coverage under Medicare without paying a premium.
a seventy-year-old man who has paid FICA taxes for twenty calendar quarters
ZPIC
a type of federally regulated insurance plan that provides coverage in addition to medicare part B
A Medigap plan is
an insurance offered by private insurance
