mbc 112 w4 quiz

The Medicare Advantage Plan option that provides various health insurance plan options for Medicare beneficiaries to select from to meet their specific health care needs is Medicare Part:

. C.

The responsibilities of the Center for Medicaid and State Operations include which of the following?

. Develop national Medicaid policies and procedures.

Which procedure is performed for definitive treatment of the principal diagnosis or the procedure that most closely relates to the principal diagnosis?

. Principal

Which of the following procedures is a significant procedure?

. Surgery

What is the insurance company called that is responsible to pay the claim after the primary and secondary payers have issued a payment determination?

. Tertiary payer

In accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations, standard formats for electronic transactions have been adopted. The adopted standard formats were developed by the American National Standards Institute (ANSI). The standard transaction format for the CMS-1450 (UB-04) is:

. Version 5010.

Medicare Part A coverage includes: Select one:

. hospital insurance.

Major categories of coverage under Medicare Part A are _____ services.

. inpatient

An insurance claim form is completed by providers for the purpose of submitting charges for medical services and supplies to:

. providers. b. patients. c. third-party payers. d. all of the above. answer is d

Coverage for medically necessary physician and outpatient services, including laboratory tests, X-ray examinations, physical therapy, emergency room services, and ambulatory surgery services, is provided under Medicare Part:

B

The part of Medicare that covers medical expenses incurred for physician services, outpatient diagnostic and therapeutic services, clinical laboratory services, home health care, outpatient hospital treatment, and blood required if medically necessary is Part:

B.

Patient diagnosis information is reported in which of the following sections on the CMS-1500 claim form?

Blocks 14 to 23

Health Care Common Procedure Coding System (HCPCS) Level I and II codes describing hospital outpatient services are reported on the CMS-1450 (UB-04) in what form locator (FL)?

FL 44

Which admitting diagnosis code describes the condition, sign, symptom, illness, injury, disease, or other reason why the patient was admitted and it is entered in this field? Select one:

FL 69

The laws that outline coverage circumstances where Medicare is not the primary payer are called _____ laws.

Medicare Secondary Payer

What is the process by which a claim form is scanned and data on the claim are transferred into a computer system?

Optical scanning

Disadvantages of which claim submission method are that claims can be lost and there is no tracking?

Paper claim

What type of procedure code is recorded in FL 74 a-e on a claim for date of service October 1, 2013?

b. ICD-9-CM Volume III

Medicaid programs vary by state because each state designs its own program and has the flexibility to:

b. determine the type, amount, duration, and scope of services.

Two methods of claim form submission are manual and electronic transmission, which are transmitted through:

b. electronic data interchange (EDI).

Which of the following is a managed care plan?

c. Health maintenance organization (HMO)

In 1994 the Department of Defense introduced a three-tier program called TRICARE. The three types of Tricare plans available are:

c. TRICARE Standard, TRICARE Prime, and TRICARE Extra.

The Comprehensive Health Insurance Plan CHIP program is administered at the state level, and each state has the flexibility to set coverage guidelines; however, in accordance with federal law, CHIP programs must provide coverage for basic services such as:

doctor's visits, immunizations, emergency room visits, and hospitalization

Examples of significant procedures include:

infusions.

A Medigap plan is a supplemental insurance plan purchased by a Medicare beneficiary to provide coverage for amounts not paid by Medicare such as:

noncovered services or items, the annual deductible, and coinsurance amounts.