Exam 13: Medicare Medical Billing

When an individual has Medicare and a Medigap policy, the reassignment of the gaps in coverage is known as __________ .

Medicare patients with Part B fee-for-service benefits are responsible for what percentage of the Medicare Fee Schedule (MFS) after the deductible has been met and services are rendered by a provider who accepts assignment? A)15% B)20% C)25% D)30%

Coverage for hospice care is provided by: A)Medicare Part A. B)Medicare Part B. C)Medicare Part D. D)Medicare Advantage (MA).

What role does the Social Security Administration (SSA) play in the Medicare program?

The Physician Quality Reporting Initiative (PQRI) is a: A)mandatory quality reporting program. B)voluntary quality reporting program that requires enrollment by physicians. C)voluntary quality reporting program that requires registration by physicians. D)voluntary quality reporting program that includes financial incentives.

Only Medicare participating providers are required to file claims on behalf of Medicare patients.

The types of Medicare Advantage plans include health maintenance organizations (HMOs).

Routinely waiving coinsurance and/or deductibles for Medicare patients when the patient has the ability to pay is considered abuse.

All Medicare beneficiaries are automatically enrolled in Medicare Part D.

The Medicare program that provides expanded benefits through private managed care health plans is: A)Medicare Part A. B)Medicare Part B. C)Medicare Part D. D)Medicare Advantage (MA).

Medicare prescription drug coverage is offered through: A)Medicare Part A. B)Medicare Part B. C)Medicare Part D. D)Medicare Advantage (MA).

Medicare Part B insurance helps pay for all of the following services EXCEPT: A)hospital inpatient care provided by a physician. B)hospital outpatient care provided by a physician. C)inpatient laboratory and diagnostic services. D)ambulance transportation.

The Medicare program is administered by the Centers for Medicare and Medicaid Services (CMS), a division of the United States Department of Health and Human Services.

All of the following are considered physicians by Medicare EXCEPT a(n): A)doctor of osteopathy. B)optometrist. C)doctor of dental medicine. D)physical therapist.

Medicare Part A contractors were formerly referred to as intermediaries.

Hearing aids are NOT routinely covered by Medicare.

Which of the following is true of nonparticipating providers who accept assignment?

For each benefit period, a Medicare Part A beneficiary will receive coverage for: A)30 days of hospital care. B)60 days of hospital care. C)90 days of hospital care. D)unlimited days of hospital care if medically necessary.

Certain organ transplants are covered under Part A as long as: A)a second opinion has been obtained prior to the surgery. B)services are performed in a hospital that is an approved Medicare provider. C)the patient has not exceeded his or her Part A benefit limit. D)an in-home caregiver will be available to care for the patient after surgery.

For a service to be considered medically necessary by Medicare, which of the following criteria must be met? A)It is delivered at the most appropriate level. B)It is an elective procedure. C)It is an investigational procedure. D)It is performed for the patient's convenience.