Exam 13: Medicare Medical Billing

The organization that enrolls new Medicare beneficiaries into the program is the: A)Centers for Medicare and Medicaid Services (CMS). B)Department of Health and Human Services (DHHS). C)Internal Revenue Service (IRS). D)Social Security Administration (SSA).

What additional services are covered by some Medicare Advantage plans?

List two practices that are common types of Medicare abuse.

In which of the following cases involving a patient who is age 65 or older is Medicare considered the primary payer? A)The patient's condition is the result of an automobile accident. B)The patient works for an employer with 20 or fewer employees. C)The patient has group health insurance through a working spouse. D)The patient's injury or condition is covered by workers' compensation.

The original Medicare plan is based on which type of payment method? A)Per diem B)Capitation C)Fee-for-service D)Sliding scale

When a provider has agreed to accept the allowed charge for a service as payment in full, it is known as: A)discounted billing. B)accepting assignment. C)accepting contract terms. D)fraud.

Part C is the Medicare option that allows beneficiaries to enroll in their choice of managed care plan, known as a Medicare Advantage plan.

Part A provider certification is obtained through formal inspections by state agencies.

Medicare Part D consists of: A)home healthcare coverage. B)wellness coverage. C)prescription drug coverage. D)long-term-care coverage.

The __________ notice is a notification to a Medicare patient that the services to be provided may NOT be covered by Medicare because they are NOT medically necessary, and the patient is responsible for the charges.

Medicare Part A provides coverage for all of the following services EXCEPT: A)inpatient hospital care. B)inpatient physician services. C)home health care. D)hospice care.

For Medicare Part A, a deductible applies: A)to each benefit period. B)to each household. C)to each hospital admission. D)only if skilled nursing care is provided.

For each benefit period, a Medicare Part A beneficiary will receive coverage for how many days of skilled nursing care? A)30 days B)60 days C)90 days D)100 days

When referring to Medicare, MSP refers to: A)Medical specialty providers. B)Medicare supplement plans. C)Medicare secondary payer. D)Medicare services and plans.

Once a Medicare patient has been hospitalized for 60 consecutive days, during the next 30 days of hospitalization the patient is responsible for paying __________ .

Organizations that are hired by the CMS to carry out day-to-day Medicare program operations are known as: A)administrators. B)contractors. C)intermediaries. D)carriers.

The role of the Centers for Medicare and Medicaid Services (CMS) includes all of the following EXCEPT: A)paying claims for Medicare beneficiaries. B)establishing policy for provider reimbursement. C)conducting research of healthcare management and treatment. D)assessing the quality of healthcare facilities and services.

Hospice services covered under Medicare Part A may be provided as: A)short-term hospital care. B)inpatient respite care. C)in-home care. D)all of the above.

The Medicare document that patients sign to authorize the release of information for claims processing and payment is the __________ Claim Authorization and Information Release form.