Exam 9: Conquering Medicare’s Challenges

Medicare's fiscal year runs from January 1 to December 31 of each year.

Part A Medicare beneficiaries are allowed only one "benefit period" per year.

When a service or procedure meets Medicare's criteria for coverage,it is said to be:

The HMO is the most expensive and least restrictive type of Medicare managed care plan.

Part _____ of Medicare helps pay for charges incurred during an inpatient hospital stay.

Submitting claims electronically is normally less expensive for both providers and Medicare.

Medicare is always the "payer of last resort."

There are no exceptions to HIPAA's mandatory electronic claim submission rule.

An individual cannot qualify for both Medicare and Medicaid.

Part _____ of Medicare helps pay for physician and outpatient charges.

List three advantages of providers becoming PAR.

An individual who has traditional Medicare Parts A and B is required to have a Medigap policy.

For durable medical equipment (DME)to qualify for Medicare payment,it must be ordered by a physician for use in the home and items must be reusable.

Define a remittance advice,and describe the information it contains.

Workers' compensation would likely be a primary payer to Medicare.

Providers must purchase the software required for electronic claims submission from HIPAA.

In January of 1999,the Balanced Budget Act (BBA)of 1997 went into effect,expanding the role of private plans to include ____________________.

Explain why the information contained in Chapter 9 (Medicare)is important to the health insurance professional.

______ was established to set quality standards for all laboratory testing to ensure the safety,accuracy,reliability,and timeliness of patient test results regardless of where the test was performed.

A physician,practitioner,facility,or supplier with fewer than 10 FTE employees is considered a: