Exam 12: Medicare

Nonparticipating physicians have an option regarding accepting assignment on the Medicare patient.

The 1987 Omnibus Budget Reconciliation Act (OBRA) established the

What type of coverage does a Medi-Medi patient have?

Medicare provides insurance for disabled workers of any age.

In the Medicare program, a physical examination is a covered benefit when performed within 12 months of enrollment.

Medicare Part B

Employee and employer contributions help pay for Medicare Part A health services.

Medicare Part B insurance payments are all handled by the National Blue Cross Association.

A Medicare prepayment screen

The frequency of Pap tests that may be billed for a Medicare patient who is low risk is

The alpha letter ____________________ following the identification number on a female patient's Medicare card indicates that it is her husband's number.

The letters preceding the number on the patient's Medicare identification card indicate

When a Medicare beneficiary has employer supplemental coverage, Medicare refers to these plans as

Medicare's remittance advice document was formerly known as the explanation of Medicare benefits.

When a remittance advice (RA) is received from Medicare, the insurance billing specialist should

Once a patient changes from Medicare to a senior HMO, the patient may change plans during an open enrollment period in the spring of each year.

Scenario: The following questions pertain to a participating physician who bills Medicare $480; Medicare allows $400, and the patient has met the Medicare deductible for the calendar year. -What is the courtesy adjustment?

Medicare provides a onetime baseline mammographic examination for women ages 35-39 and preventive mammogram screenings for women 40 years or older

When a Medicare patient signs an advance beneficiary notice, the procedure code for the service provided must be modified using the HCPCS Level II modifier

Funds for Medicare Part B come equally from those who sign up for it and the federal government.