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Med. Insurance Terms
Medical Insurance in a Flash Chapter 8
| Question | Answer |
|---|---|
| What percentage of the allowed amount is paid by Medicare? | 80% |
| What percentage of the allowed amount is paid by a secondary insurer? | 20% |
| What is the capitated Medicare plan called? | Medicare HMO |
| One of the colorectal screening tests covered Medicare? | Referral |
| Medicare HMO patients must obtain one of these before going for tests or to a specialist? | Occult blood in stool, flexible sigmoidoscopy, colonoscopy, or brain enema |
| Medicare will pay for a discontinued service if it is billed with that modifier? | Modifier-53 |
| What is the name of the suplemental insurance that is provided by private insurance? | Medigap |
| What is the estimated number of americans with low bone mass? | 34 Million |
| What is the disease of the optic nerve for which Medicare covers a screening test? | Glaucoma |
| A Medicare Summary Notice was previously called what? | Explanation of Medicare Benefits / EOMP / EOB |
| What is the name of the test used to look for polyps in the lower third of the colon? | Fiberoptic sigmoidoscopy |
| How often can Medicare patients have a fiberoptic sigmoidoscopy? | Every 4 years for Medicare patients over 50 and not at high risk |
| Hyperparathyroidism is an indication for what testing? | Bone mass measurements |
| What are two screening tests performed for prostate cancer? | PSA and DRE |
| What are the three high-risk patient groups for coverage of glaucoma screening? | Patients with diabetes mellitus patients with a family history of glaucoma African Americans age 50 and over |
| What ethnic group is most likely to be at risk of prostate cancer? | African American |
| To whom is the medicare summary notice sent? | The Patient |
| What are the coverage conditions for medicare coverage of pneumococcal vaccine (PPV)? | Medicare will cover one vaccination in the lifetime of the patient. |
| How often are Medicare summary notices mailed? | Every 90 Days. |
| Medicare patients are not required to pay co-insurance or a deductible for what two vaccines? | Influenza and pneumococcal |
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BHC Medical Assisting
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