Question 1

Medicare Part D covers long-term (nursing home)care.

Accepted Answer

A) True 
 B)False

Question 2

Medicare claims may be electronically submitted from a provider's office to a:

Accepted Answer

A)  fiscal intermediary (FI). 
B)  Medicare administrative contractor. 
C)  DME MAC. 
D)  all of the above 
A)  fiscal intermediary (FI). 
B)  Medicare administrative contractor. 
C)  DME MAC. 
D)  all of the above

Question 3

Individuals pay for Medicare Part B coverage through:

Accepted Answer

A)  wage deductions. 
B)  monthly premiums. 
C)  personal checks. 
D)  electronic funds transfers. 
A)  wage deductions. 
B)  monthly premiums. 
C)  personal checks. 
D)  electronic funds transfers.

Question 4

The letter "A" following a beneficiary's Social Security number on the HICN indicates the individual was a wage earner.

Accepted Answer

A) True 
 B)False

Question 5

Medicare managed care plans fill "gaps" in basic Medicare similar to Medigap policies.

Accepted Answer

A) True 
 B)False

Question 6

Medicare now pays for certain screening procedures in their "Welcome to Medicare" program.

Accepted Answer

A) True 
 B)False

Question 7

With all Medicare HMO options,enrollees are allowed to see out-of-network providers and receive services from specialists without first going through a primary care physician,called self-referring.

Accepted Answer

A) True 
 B)False

Question 8

A special needs plan (SNP)is a type of Medicare Advantage plan designed to attract and enroll Medicare beneficiaries who fall into a certain specific needs classification.

Accepted Answer

A) True 
 B)False

Question 9

Only Medicare beneficiaries can file an appeal.

Accepted Answer

A) True 
 B)False

Question 10

All Medicare Advantage plans offer the exact same coverage as original Medicare.

Accepted Answer

A) True 
 B)False

Question 11

When a Medicare claim is filed,the beneficiary receives a document explaining the claim adjudication called a/an:

Accepted Answer

A)  SPRA. 
B)  MSN. 
C)  ABN. 
D)  EOB. 
A)  SPRA. 
B)  MSN. 
C)  ABN. 
D)  EOB.

Question 12

Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an:

Accepted Answer

A)  secondary claim. 
B)  grievance. 
C)  appeal. 
D)  ABN. 
A)  secondary claim. 
B)  grievance. 
C)  appeal. 
D)  ABN.

Question 13

After beneficiaries (who are enrolled in original Medicare)satisfy the yearly deductible,they pay a 20% copayment of all "allowable" charges.

Accepted Answer

A) True 
 B)False

Question 14

Medicare premiums,deductibles,and penalty amounts are subject to change every year.

Accepted Answer

A) True 
 B)False

Question 15

Medicare Part A covers custodial and long-term care.

Accepted Answer

A) True 
 B)False

Question 16

A claim for which a beneficiary elects to assign his or her benefits under a Medigap policy to a PAR is called a:

Accepted Answer

A)  mandated Medigap transfer. 
B)  assignment of benefits. 
C)  coordination of benefits. 
D)  Medicare claim allocation. 
A)  mandated Medigap transfer. 
B)  assignment of benefits. 
C)  coordination of benefits. 
D)  Medicare claim allocation.

Question 17

One of the cost-sharing requirements of Medicare Part B is an annual deductible which is subject to change annually,after which Medicare pays ____ percent of ______________.

Accepted Answer

80,allowab

Question 18

List four coverage choices under Medicare Part C.

Accepted Answer

Preferred provider organizations (PPOs)

Question 19

Coverage with Medicare Part C (Medicare Advantage plans)typically includes both Part A and Part B expenses.

Accepted Answer

A) True 
 B)False

Question 20

Medicare Part C was previously called ___________;it was renamed by The Medicare Prescription,Improvement,and Modernization Act of 2003 (MMA)and is now called ___________.

Accepted Answer

Medicare+C

Medicare Part D covers long-term (nursing home)care.

Medicare claims may be electronically submitted from a provider's office to a:

Individuals pay for Medicare Part B coverage through:

The letter "A" following a beneficiary's Social Security number on the HICN indicates the individual was a wage earner.

Medicare managed care plans fill "gaps" in basic Medicare similar to Medigap policies.

Medicare now pays for certain screening procedures in their "Welcome to Medicare" program.

With all Medicare HMO options,enrollees are allowed to see out-of-network providers and receive services from specialists without first going through a primary care physician,called self-referring.

A special needs plan (SNP)is a type of Medicare Advantage plan designed to attract and enroll Medicare beneficiaries who fall into a certain specific needs classification.

Only Medicare beneficiaries can file an appeal.

All Medicare Advantage plans offer the exact same coverage as original Medicare.

When a Medicare claim is filed,the beneficiary receives a document explaining the claim adjudication called a/an:

Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an:

After beneficiaries (who are enrolled in original Medicare)satisfy the yearly deductible,they pay a 20% copayment of all "allowable" charges.

Medicare premiums,deductibles,and penalty amounts are subject to change every year.

Medicare Part A covers custodial and long-term care.

A claim for which a beneficiary elects to assign his or her benefits under a Medigap policy to a PAR is called a:

One of the cost-sharing requirements of Medicare Part B is an annual deductible which is subject to change annually,after which Medicare pays percent of __________.

List four coverage choices under Medicare Part C.

Coverage with Medicare Part C (Medicare Advantage plans)typically includes both Part A and Part B expenses.

Medicare Part C was previously called _;it was renamed by The Medicare Prescription,Improvement,and Modernization Act of 2003 (MMA)and is now called _.

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Military Carriers

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

Keys to Successful Claims Management

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

Filters

Exam 9: Conquering Medicare’s Challenges

Medicare Part D covers long-term (nursing home)care.

Medicare claims may be electronically submitted from a provider's office to a:

Individuals pay for Medicare Part B coverage through:

The letter "A" following a beneficiary's Social Security number on the HICN indicates the individual was a wage earner.

Medicare managed care plans fill "gaps" in basic Medicare similar to Medigap policies.

Medicare now pays for certain screening procedures in their "Welcome to Medicare" program.

With all Medicare HMO options,enrollees are allowed to see out-of-network providers and receive services from specialists without first going through a primary care physician,called self-referring.

A special needs plan (SNP)is a type of Medicare Advantage plan designed to attract and enroll Medicare beneficiaries who fall into a certain specific needs classification.

Only Medicare beneficiaries can file an appeal.

All Medicare Advantage plans offer the exact same coverage as original Medicare.

When a Medicare claim is filed,the beneficiary receives a document explaining the claim adjudication called a/an:

Beneficiaries who are not satisfied with the amount of a claim reimbursement may file a/an:

After beneficiaries (who are enrolled in original Medicare)satisfy the yearly deductible,they pay a 20% copayment of all "allowable" charges.

Medicare premiums,deductibles,and penalty amounts are subject to change every year.

Medicare Part A covers custodial and long-term care.

A claim for which a beneficiary elects to assign his or her benefits under a Medigap policy to a PAR is called a:

One of the cost-sharing requirements of Medicare Part B is an annual deductible which is subject to change annually,after which Medicare pays ____ percent of ______________.

List four coverage choices under Medicare Part C.

Coverage with Medicare Part C (Medicare Advantage plans)typically includes both Part A and Part B expenses.

Medicare Part C was previously called ___________;it was renamed by The Medicare Prescription,Improvement,and Modernization Act of 2003 (MMA)and is now called ___________.

The Origins of Health Insurance

Tools of the Trade: A Career as a Health (Medical)Insurance Professional

The Legal and Ethical Side of Medical Insurance

Types and Sources of Health Insurance

Claim Submission Methods

Traditional Fee For Service/Private Plans

Unraveling the Mysteries of Managed Care

Understanding Medicaid

Military Carriers

Miscellaneous Carriers: Workers’ Compensation and Disability Insurance

Diagnostic Coding

Procedural, Evaluation and Management, and HCPCS Coding

The Patient

Keys to Successful Claims Management

The Role of Computers in Health Insurance

Reimbursement Procedures: Getting Paid

Hospital Billing and the UB-04

Filters

One of the cost-sharing requirements of Medicare Part B is an annual deductible which is subject to change annually,after which Medicare pays percent of __________.

Medicare Part C was previously called _;it was renamed by The Medicare Prescription,Improvement,and Modernization Act of 2003 (MMA)and is now called _.