Question 1

Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called

Accepted Answer

A)  local intermediaries. 
B)  regional intermediaries. 
C)  fiscal intermediaries. 
D)  fiscal agents. 
A)  local intermediaries. 
B)  regional intermediaries. 
C)  fiscal intermediaries. 
D)  fiscal agents.

Question 2

A program that contracts with CMS to review medical necessity and appropriateness of inpatient medical care is known as a

Accepted Answer

A)  QIO. 
B)  PCP. 
C)  HMO. 
D)  HHS. 
A)  QIO. 
B)  PCP. 
C)  HMO. 
D)  HHS.

Question 3

Payments to hospitals for Medicare services are classified according to

Accepted Answer

A)  CPT codes. 
B)  ICD-9-CM codes. 
C)  DRGs. 
D)  PTMs. 
A)  CPT codes. 
B)  ICD-9-CM codes. 
C)  DRGs. 
D)  PTMs.

Question 4

A specialized insurance policy that is predefined by the federal government for the Medicare beneficiary to cover the deductible and copayment amounts is referred to as _________________________.

Accepted Answer

The answer of A specialized insurance policy that is predefined...

Question 5

Medicare is a

Accepted Answer

A)  state health insurance program. 
B)  federal health insurance program. 
C)  regional health insurance program. 
D)  local health insurance program. 
A)  state health insurance program. 
B)  federal health insurance program. 
C)  regional health insurance program. 
D)  local health insurance program.

Question 6

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 patient's financial responsibility?

Accepted Answer

The answer of Scenario: The following questions pertain to a...

Question 7

Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility.

Accepted Answer

A) True 
 B)False

Question 8

When a Medicare patient's payment authorization is on file, the abbreviation ____________________ may be used on the CMS-1500 claim form.

Accepted Answer

The answer of When a Medicare patient's payment authorization is...

Question 9

The Part B Medicare annual deductible is

Accepted Answer

A)  $60. 
B)  $162. 
C)  $150. 
D)  $760. 
A)  $60. 
B)  $162. 
C)  $150. 
D)  $760.

Question 10

Medigap insurance may cover

Accepted Answer

A)  all physician and hospital deductibles. 
B)  the deductible not covered under Medicare. 
C)  80% of the Medicare allowed amount. 
D)  75% of the Medicare allowed amount. 
A)  all physician and hospital deductibles. 
B)  the deductible not covered under Medicare. 
C)  80% of the Medicare allowed amount. 
D)  75% of the Medicare allowed amount.

Question 11

Because Medicare is a federal program providing uniform benefits, payment of each medical service rendered to Medicare patients is consistent across the United States.

Accepted Answer

A) True 
 B)False

Question 12

The Civil Monetary Penalties Law carries a sanction for a penalty of ____________________ for a physician who fails to electronically transmit or manually submit a Medicare claim.

Accepted Answer

The answer of The Civil Monetary Penalties Law carries a...

Question 13

What does TEFRA stand for?

Accepted Answer

Tax Equity

Question 14

Medigap payments go directly to the beneficiary.

Accepted Answer

A) True 
 B)False

Question 15

Benefits of Medigap policies may vary from one state to another.

Accepted Answer

A) True 
 B)False

Question 16

A patient classified with ESRD may be provided benefits from Medicare. What does ESRD stand for?

Accepted Answer

End-stage

Question 17

Medicare transmits Medigap claims electronically for participating physicians when Medigap information is provided on the original Medicare claim.

Accepted Answer

A) True 
 B)False

Question 18

The letter "D" following the identification number on the patient's Medicare card indicates a

Accepted Answer

A)  disabled adult. 
B)  disabled child. 
C)  wage earner. 
D)  widow. 
A)  disabled adult. 
B)  disabled child. 
C)  wage earner. 
D)  widow.

Question 19

The patient's authorized signature is not required on the CMS-1500 claim form for Medicare-Medicaid cases.

Accepted Answer

A) True 
 B)False

Question 20

Some senior HMOs may provide services not covered by Medicare, such as

Accepted Answer

A)  laboratory and x-ray services. 
B)  vaccines and ambulance services. 
C)  mammograms and Pap smears. 
D)  eyeglasses and prescription drugs. 
A)  laboratory and x-ray services. 
B)  vaccines and ambulance services. 
C)  mammograms and Pap smears. 
D)  eyeglasses and prescription drugs.

Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called

A program that contracts with CMS to review medical necessity and appropriateness of inpatient medical care is known as a

Payments to hospitals for Medicare services are classified according to

A specialized insurance policy that is predefined by the federal government for the Medicare beneficiary to cover the deductible and copayment amounts is referred to as _________________________.

Medicare is a

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 patient's financial responsibility?

Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility.

When a Medicare patient's payment authorization is on file, the abbreviation ____________________ may be used on the CMS-1500 claim form.

The Part B Medicare annual deductible is

Medigap insurance may cover

Because Medicare is a federal program providing uniform benefits, payment of each medical service rendered to Medicare patients is consistent across the United States.

The Civil Monetary Penalties Law carries a sanction for a penalty of ____________________ for a physician who fails to electronically transmit or manually submit a Medicare claim.

What does TEFRA stand for?

Medigap payments go directly to the beneficiary.

Benefits of Medigap policies may vary from one state to another.

A patient classified with ESRD may be provided benefits from Medicare. What does ESRD stand for?

Medicare transmits Medigap claims electronically for participating physicians when Medigap information is provided on the original Medicare claim.

The letter "D" following the identification number on the patient's Medicare card indicates a

The patient's authorized signature is not required on the CMS-1500 claim form for Medicare-Medicaid cases.

Some senior HMOs may provide services not covered by Medicare, such as

Role of an Insurance Billing Specialist

Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Basics of Health Insurance

Medical Documentation and the Electronic Health Record

Diagnostic Coding

Procedural Coding

The Paper Claim: Cms-1500 02-12

The Electronic Claim

Receiving Payments and Insurance Problem Solving

Office and Insurance Collection Strategies

The Blue Plans, Private Insurance, and Managed Care Plans

Medicaid and Other State Programs

Tricare and Veterans Health Care

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Hospital Billing

Seeking a Job and Attaining Professional Advancement

Filters

Exam 12: Medicare

Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called

A program that contracts with CMS to review medical necessity and appropriateness of inpatient medical care is known as a

Payments to hospitals for Medicare services are classified according to

A specialized insurance policy that is predefined by the federal government for the Medicare beneficiary to cover the deductible and copayment amounts is referred to as _________________________.

Medicare is a

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 patient's financial responsibility?

Each Medicare hospital benefit period consists of 60 consecutive days in a hospital or nursing facility.

When a Medicare patient's payment authorization is on file, the abbreviation ____________________ may be used on the CMS-1500 claim form.

The Part B Medicare annual deductible is

Medigap insurance may cover

Because Medicare is a federal program providing uniform benefits, payment of each medical service rendered to Medicare patients is consistent across the United States.

The Civil Monetary Penalties Law carries a sanction for a penalty of ____________________ for a physician who fails to electronically transmit or manually submit a Medicare claim.

What does TEFRA stand for?

Medigap payments go directly to the beneficiary.

Benefits of Medigap policies may vary from one state to another.

A patient classified with ESRD may be provided benefits from Medicare. What does ESRD stand for?

Medicare transmits Medigap claims electronically for participating physicians when Medigap information is provided on the original Medicare claim.

The letter "D" following the identification number on the patient's Medicare card indicates a

The patient's authorized signature is not required on the CMS-1500 claim form for Medicare-Medicaid cases.

Some senior HMOs may provide services not covered by Medicare, such as

Role of an Insurance Billing Specialist

Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Basics of Health Insurance

Medical Documentation and the Electronic Health Record

Diagnostic Coding

Procedural Coding

The Paper Claim: Cms-1500 02-12

The Electronic Claim

Receiving Payments and Insurance Problem Solving

Office and Insurance Collection Strategies

The Blue Plans, Private Insurance, and Managed Care Plans

Medicaid and Other State Programs

Tricare and Veterans Health Care

Workers Compensation

Disability Income Insurance and Disability Benefit Programs

Hospital Billing

Seeking a Job and Attaining Professional Advancement

Filters