Exam 9: Conquering Medicare’s Challenges

Medicare Part A helps pay for all of the following,except:

Insurance coverage that is typically primary to Medicare includes all of the following,except:

The Tax Relief and Health Care Act (TRHCA)of 2006 established a Physician Quality Reporting System referred to as:

The private organization that determines payment of Part B covered items and services is called a peer review organization (PRO).

Most Medicare Part B beneficiaries pay for Part B coverage in the form of a premium deducted from their monthly Social Security check.

Medicare's fee schedule is based on a system whereby each payment value is found within a range of payments known as:

A private insurance company that serves as the federal government's agent in the administration of the Medicare program,including the payment of claims.

Individual plans,such as group health insurance plans that include prescription coverage,offer varying benefits;however,they must offer no less than the basic Medicare coverage,referred to as ____________________.

The length of time Medicare uses for hospital and skilled nursing facility (SNF)services is called a/an ____________________.

There are 20 standard Medigap policies.

Medicare Part A is free to those who have _____ or more quarters of Social Security work credits.

Postpayment Medicare audits are often triggered by statistical irregularities.

Medicare HMO member/enrollees must receive care only from the providers in the network except in emergencies.

When an individual turns 65 and enrolls in Medicare,federal law forbids insurance companies from denying eligibility for Medigap policies for 6 months.

The CMS-1500 paper claim form cannot be used for Medicare claims submission.

The term used when Medicare is not responsible for paying first because of coverage under another insurance policy is:

The ________________ mandated by the Social Security Act is activated when (1)a PAR Medicare provider includes a specific identifier-a COBA ID number-on the beneficiary's claim and (2)assigns payment benefits to that provider.

List the information typically included on an MSN.

A federal insurance program,established in 1966,for people 65 years old and older and certain other qualifying individuals is:

Part _____ of Medicare includes Medicare Advantage options.