Exam 13: Medicare Medical Billing

What is Medicare Part D?

Which of the following information is NOT included on a Medicare beneficiary's identification card? A)Effective date of coverage B)Primary care physician's name C)Claim number D)Type of coverage

A Medicare __________ is sent to a provider when a Medicare claim has been filed but needs additional information or documentation before the claim can be processed and paid.

Under Medicare Part A, what time limit applies to coverage for home healthcare services? A)60 days per benefit period B)90 days per benefit period C)120 days per benefit period D)There is no time limit as long as medical necessity has been proven.

Nonparticipating providers who collect amounts from patients in excess of the limiting charge are subject to financial penalties.

Medicare Part C plans are offered through: A)HMO plans. B)PPO plans. C)fee-for-service plans. D)all of the above.

When a Medicare patient is covered by more than one plan and Medicare is clearly NOT the primary payer, the type of claim submitted to Medicare is a Medicare __________ payer claim.

To obtain Medicare Part B coverage, individuals must qualify by meeting eligibility requirements for Part A or: A)qualifying as a disabled individual. B)purchasing Part D coverage. C)purchasing Part A coverage. D)qualifying based on income status.

Notices sent to physicians on a regular basis that contain detailed and updated information about the coding and medical necessity of a specific service are __________ Determinations.

If a patient is more than 65 years old and works for a company with more than 100 employees, Medicare is the primary payer.

Nonparticipating providers who accept assignment receive 100% of the applicable Medicare Fee Schedule (MFS).

The Medicare Part B premium is determined by the patient's annual income.

If a veteran is entitled to Medicare benefits, he or she may choose whether to receive coverage through Medicare or through the Veterans Administration.

Medicare is considered the primary payer when an individual age 65 or older: A)is eligible for coverage through the Veteran's Administration. B)receives treatment for an accident-related claim. C)fails to apply for end-stage renal disease (ESRD)-based coverage. D)is covered by another policy that is NOT a group policy.

Explain the functions of claim-scrubbing software.

A physician who chooses NOT to participate in a Medicare health plan is known as a: A)noncontracting provider. B)nonpracticing provider. C)nonproviding provider. D)nonparticipating provider.

When receiving inpatient hospital care, a Medicare Part A beneficiary has a lifetime reserve of: A)30 days. B)60 days. C)90 days. D)unlimited days if medically necessary.

The form sent to patients by the Medicare contractor (carrier) that itemizes services billed to Medicare, the amount paid, and the amount the beneficiary is responsible for (if any) is a(n) __________ Notice.

When Medicare is the secondary payer, a copy of the primary insurance remittance notice must be submitted with the claim.

Individuals eligible for Medicare may be classified into one or more of the following categories EXCEPT: A)age 65 or older. B)disabled. C)low income. D)end-stage renal disease (ESRD).