MIT 104: CH9 Test Your Understanding

E/M services during a global period that are unrelated to the procedure can be billed with what modifier?

*-59* -25

The Medicare program

*directly pays the claims* directly pays the Medicare beneficiary

How many Medigap plans are available?

10

The coinsurance for Medicare Part B is

20 percent

ABN is the abbreviation for

Advance Beneficiary Notice

All laboratory work paid for by Medicare is regulated by

CLIA rules

CLIA is administered by

CMS

CLIA is the abbreviation for

Clinical Laboratory Improvement Amendments

CWF is the abbreviation for

Common Working File

HPSA is the abbreviation for

Health Professional Shortage Area

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

Quality Payment Program

IPPE is the abbreviation for

Initial Preventative Physical Examination

Care in a skilled nursing facility is covered under

Medicare Part A

Home health care is covered under

Medicare Part A

Hospice care is covered under

Medicare Part A

Hospital benefits are provided under

Medicare Part A

Outpatient hospital benefits are provided under

Medicare Part B

Supplemental insurance plans for Medicare beneficiaries provide additional coverage for an individual receiving benefits under which Medicare Part?

Medicare Part B

Patients receive a __________ that details the services they were provided over a thirty-day period, the amounts charged, and the amounts they may be billed.

Medicare Summary Notice

Roster billing is used to file simplified claims for certain

Medicare immunization programs

NCD is the abbreviation for

National Coverage Determination

A screening service is defined as one that is

done to discover if a patient has an undiagnosed disease

Anyone over age 65 who receives Social Security benefits is automatically

enrolled in Medicare Part A and eligible for Medicare Part B

CMS accepts only signatures that are

handwritten, electronic, facsimiles of original, and written/electronic signatures

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

CLIA is a federal law that established standards for

laboratory testing

Each Medicare enrollee receives a __________ issued by CMS.

medicare card

How many preventive physical exams does Medicare cover?

one initially

People who are over age 65 but who are not eligible for free Part A coverage may enroll by

paying a premium

The deductible for Medicare Part B is

set each year

Medicare benefits are available to individuals in how many beneficiary categories?

six

How many CMS regional offices are there?

ten

Paper claims cannot be paid before what day after receipt of the claim?

the 29th day

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

the Original Medicare Plan

Under the Medicare program, a nonparticipating physician may not bill more than 115 percent of

the approved charge on the nonPAR fee schedule

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

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

A Medigap plan is

an insurance offered by private insurance