Medical Insurance billing ch 9

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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


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