Exam 13: Medicare Medical Billing

To qualify for Medicare, disabled adults must have been receiving Social Security disability benefits for: A)1 year. B)more than 1 year. C)more than 2 years. D)more than 3 years.

A spouse of a deceased, retired, or disabled individual who was or is eligible for Medicare benefits: A)is not eligible for Medicare coverage. B)is also eligible for Medicare coverage. C)must apply for Medicaid benefits. D)is eligible for Supplemental Security Income benefits.

Medicare Part B premiums are determined by the beneficiary's: A)health status. B)annual income. C)geographic location. D)age.

Physicians who are NOT participating and NOT accepting assignment from Medicare can charge: A)the usual, customary, and reasonable fee for services. B)no more than 115% of the nonparticipating provider Medicare Fee Schedule (MFS). C)the rate as shown on the nonparticipating provider Medicare Fee Schedule (MFS). D)no more than 110% of the nonparticipating provider Medicare Fee Schedule (MFS).

Under what circumstance would emergency department services be covered by Part B?

Items that are NOT covered by Medicare Part A or Part B include: A)long-term care, such as custodial care in a nursing home. B)care in a skilled nursing facility (SNF) after a 3-day hospital stay. C)care provided by a rural health clinic. D)home healthcare.

The Medicare coverage that pays for physician services is: A)Medicare Part A. B)Medicare Part B. C)Medicare Part D. D)Medicare Advantage (MA).

An additional health insurance policy sold by a private carrier that provides limited coverage for services that Medicare does NOT cover is known as a: A)Medicare Part C plan. B)Medicare secondary plan. C)Medicaid plan. D)Medigap plan.

What is a Medicare benefit period?

The types of Medicare Advantage managed care plans include: A)PPO plans. B)HMO plans. C)PPO and HMO plans. D)traditional fee-for-service plans.

Individuals with end-stage renal disease (ESRD) are Medicare eligible.

Medicare beneficiaries include individuals age 65 and older and low-income individuals.

Offering, accepting, or soliciting bribes, rebates, or kickbacks is considered fraud.

Information included on a Medicare identification card includes the A)name of the beneficiary. B)Medicare claim number. C)type of coverage. D)effective dates.

The abbreviation ESRD stands for: A)ending symptoms of renal disease. B)early status of respiratory distress. C)end-stage respiratory distress. D)end-stage renal disease.

A Medicare beneficiary has a lifetime reserve of 90 days of coverage that can be used to cover inpatient hospital services.

Private-duty nursing care is: A)covered by Medicare Part A. B)covered by Medicare Part B. C)covered by Medicare Part C. D)not covered by Medicare.

The Medicare coverage that consists of hospital insurance is: A)Medicare Part A. B)Medicare Part B. C)Medicare Part D. D)Medicare Advantage (MA).

List the four most common types of Medicare fraud.

The Program of All-Inclusive Care for the Elderly (PACE) is a program for low-income elderly individuals that is: A)a Medicaid program. B)a joint Medicare-Medicaid program. C)a program funded by private insurers. D)a state-run program.