Medicare questions
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| A federal violation occurs in Medicare if "Signature on File" is stated on the CMS-1500 form, but records do not include this. | True
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| In a staff model HMO, providers are hired directly by the health plan that pays their salary? | True
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| Medicaid is not so much an insurance program as an assistance program? | True
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| A physician who is incorporated is considered an employee under worker's compensation laws? | True
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| A paper claim is one that is submitted on paper, then optically scanned and converted to electronic form by the insurance company? | True
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| In a point of service (POS) program, members may choose to use a nonprogram provider at an time? | True
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| Medicaid is administered by federal funding only? | False
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| Waiting periods affect worker's compensation medical and hospital benefits? | False
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| List all services on the insurance claim form, including "No Charge" services? | False
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| Managed Care Plans allow laboratory tests to be performed at any facility the patient chooses? | False. Think CLIA Law.
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| A physician may accept or refuse MEDICAID patients on the basis of the individual patient and his/her circumstances? | False
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| It is believed that the longer the injured person remains out of work, the better the chance of recovery and return to the workplace? | False
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| According to OCR guidelines, all information 0n the CMS 1500 claim form should be typed in UPPER CASE? | True
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| Managed care plans NEVER require a CMS 1500 claim form to be completed and submitted? | False
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| Family Planning is a MEDICAID basic benefit? | True
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| Authorization to treat a patient with an industrial injury may be obtained over the telephone? | True
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| A copayment in a managed care plan is usually a fixed dollar amount? | True
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| If a service is totally disallowed by Medicaid, a physician is within legal rights to bill the patient? | True
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| Disability Income Policies do not provide medical expense benefits? | True
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| Medicare provides insurance for disabled workers of any age? | True
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| Prior approval or authorization is never required in the MEDICAID Program? | False
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| Temporary disability exists when an illness or injury prevents a person from performing one or more of the functions of his/her regular job? | False
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| Each Medicare Hospital Benefit consists of 60 consecutive days in a hospital or nursing facility? | False. Why?
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| When Medicaid and a third party payer covers the patient, Mediciad is always the payer of last resort? | True
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| Funds for Medicare Part B, come equally from those who sign up for it and the federal government? | True
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| Providers may choose to accept TRICARE assignment on a case-by-case basis? | True. Similar to Medicare.
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| A Medicare patient with a HMO does not need a supplemental insurance policy? | True. Remember this is a Medicare C Program and usually provides for services under a supplemental plan.
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| TRICARE/CHAMPVA is usually the secondary payer when a beneficiary is enrolled in other health insurance plans? | True
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| A non-participating provider who is not accepting assignment may bill the any fee he/she wishes? | True, but can only collect up to the limiting charge.
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| Medicare transmits Medigap claims electronically for participating providers when Medigap information is provided on the original Medicare Claim? | True. Cross-over claim
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| Medigap payments go directly to the beneficiary? | False.
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| The health insurance claim form (CMS1500) is known as the? | Universal claim form.
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| America's oldest privately owned prepaid medical group is the? | Ross-Loos Medical Group (Now known as Cigna)
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| The Social Security Acr of 1935 did what? | Set up the public assistance program.
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| The statutes for worker compensation laws fall under? | Federal and State compensation laws.
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| Office visits may be grouped on the insurance claim form if each visit is? | Is consecutive, uses the same procedure code, and results in the same fee.
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| Medicaid is administered by the? | State Government with partial federal funding.
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| What plan allows members of Kaiser Permanente Medical Care Program to seek medical help help form non-Kaiser physicians? | Point of Service.
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| An abnormal condition caused by exposure to environmental factors associated with emploment is termed a/an? | Occupational illness.
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| A significant contribution to HMO development was the? | Health Maintenance Act of 1973
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| For Medicaid the time limit to appeal a claim varies from state to state, but is usually? | 30-60 days.
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| When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known as? | Capatation.
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| Premiums for worker's compensation insurance are payed by the? | Employeer
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| What is the name of an organization of physicians sponsored by a state or a local medical association that is concerned with the development and delivery of medical services and the cost of health care? | Foundation for Medical Care.
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| Tricare, formerly known as CHAMPUS, is funded through? | Congress
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| The CMS-1500 claim form is divided into which of the following major sections? | Patient and Physician Information.
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| An organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a/an? | Preferred Provider Organization (PPO)
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| The simplest type of workers; compensation claim is? | Nondisability (ND)
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| Practitioners in an HMO program ma come under peer review b a professional group called? | Qualit Improvement Organization
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| The health maintenance organization (HMO) provided for dependents of active dut military personnel is called? | TRICARE Prime
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| Referral of a patient recommended by one specialist to another specialist is known as? | Tertiary Care
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| An individual program of therapy using simulated or real work tasks to build strength and improve the worker's endurance toward a full day's work is known as? | Work hardening
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| What is the correct procedure to collect a copayment on a managed care plan? | Collect the copayment when the patient arrives for the office visit.
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| CHAMPVA is a/an? | Service Benefit Plan
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| The form that contains authorization for the physician to treat the injured employee is the? | Medical Service Order
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| Medicare Part A is run by? | The Center for Medicare and Medicaid Services (CMS)
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| Supplemental report(s) for patients on temporary disability should be sent to the insurance carrier how often? | After every office visit.
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| Medicare Part A covers? | Hospice Care
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| Medicare Part B covers? | Diagnostic tests.
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| What are the two programs that the Social Security Administration manages that pay monthly disability benefits to people younger than 65 who cannot work for at least a year? | SSDI and SSI
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| Medigap insurance may cover? | The deductible not covered under Medicare.
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| A participating physician with the Medicare plan agrees to accept? | 80% of the Medicare approved charge.
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| The time limit for submitting a Medicare claim is? | The end of the calendar ear following the fiscal year in which sevices where performed.
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| NPI | National Provider Indentifier
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| MCO | Managed Care Organization
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| CMS | Center for Medicare and Medicaid Services
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| SSDI | Social Security Disability Insurance
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| SSI | Supplemental Security Income
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| Last session, I promise. Word Bank | Promise
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| Dependents of individuals who have died as a result of a service-connected injury qualify to receive (blank) benefits? | CHAMPVA
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| The (blank) period is the maximum amount of time for which benefits will be paid to the injured or ill person for a disability? | Benefit Period.
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| A primary care physician who controls patient access to specialists is called a/an? | Gatekeeper
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| A claim that is submitted to the insurance carrier via a dial-up modem is referred to as a (blank)? | Electronic
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| Medicare provides insurance for people (Blank) years of age or older who are retired on Social Security? | 65
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| A person who has served in the Armed Forces of the U.S., especially in time of war, who is no longer in the service and has received an honorable discharge is called a/an (Blank)? | Veteran
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| The two Medicaid eligibilty classifications are the (Blank) needy group and the (Blank) needy class? | Categorically and Medically
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| A feature that provides for twice the face amount of the policy to be paid if death results from accidental causes is called (Blank)(Blank)? | Double Indeminty
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| The legal word (Blank) means to substitute one person for another? | Subrogation.
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| A/an (Blank) is an unplanned and unexpected happening traceable to a definite time and place, causing injury not due to any fault on the part of the person injured? | Accident
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| Rehabilitation in the form of retraining, education, and job guidance and placement to assist an injured individual in finding work is called (Blank) rehabilitation? | Vocational
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| Medicaid was legally established by Title (Blank) of the Social Security Act | XIX
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| Done | Done.
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