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Fordney chptr 12
study guide
| Question | Answer |
|---|---|
| What are the requirements for disabled individuals to receive medical benefits? | Must be disabled for no less than 12 months, & must receive disability benefits for 24 months before Medicare benefits begin. |
| What are the requirements to receive Medicare Part B? | Individual(or their family) must already receive Social Security or Railroad Retirement Benefits, be age 65 or older, handicapped, kidney donor, or in end stage renal failure. |
| What age is an individual eligible to receive Medicare benefits? | At any age, so long as the patient meets with the criteria. |
| How are benefits payed for in Medicare Part B coverage? | Through an annually increasing basic premium. |
| Are immigrants eligible for Part A & B coverage? | Yes, if they have resided in the U.S. for 5 years or more. |
| How do employers contribute to Medicare Part A services? | Through monthly premiums. |
| How long is a benefit period? | From the first day you enter a hospital/NSF until no treatment is received for 60 consecutive days. |
| Is there a limit to how many benefit periods an individual can have? | No, benefit periods are unlimited. |
| What is supplementary medical insurance? | Insurance designed to help cover costs of medical care that are not covered by an individual's primary insurance. |
| Where do funds for Medicare Part B come from? | Through those who sign up for benefits, & federal government funded programs equally. |
| What services does Medicare cover for a chiropractor? | Manual manipulation for subluxation(a slight misalignment of the vertebrae of the spine). |
| Is a physical a covered benefit under Medicare? | Yes, an annual physical is covered under Medicare. |
| What are the state to state policy for Medigap? | They are the same for basic benefits, with some states varying in policy types. |
| Do patients with HMO need supplementary policies? | Only if receiving care from out of network providers and want to avoid out of pocket expenses. |
| When patients choose a Medicare Senior Plan, do they forfeit their medicare card? | No, they do not forfeit their Medicare card. |
| When patients choose an HMO plan, are they required to stay with that plan for a year? | No, they do not have to remain with it for a calendar year. |
| Do non-par physicians have the option to accept Medicare patients? | Yes, on a case by case basis. |
| Can non-par physicians charge any fee they choose? | No they may not charge any fee they choose. |
| Are Medicare reimbursement policies consistent nationwide? | No, reimbursements are not consistent nationwide. |
| Who handles Medicare Part B payments? | The patient handles the payments for Medicare Part B. |
| Another name for a fiscal intermediary is? | MAC (Medicare Administrative Contractor). |
| What does Signature On File mean? | The patient has signed authorization papers in their file, updated annually. |
| Is a patient's signature required on all CMS claim forms? | No, signature on file is sufficient. |
| What is the time limit on professional claim forms? | 12 months. |
| Does Medicaid pick up the balance on Medi/Medi claims? | No Medicaid does not pick up the balance on Medi/Medi claims. |
| For Medigap claims, does Medicare automatically transmit claims to Medigap? | Yes, if Medigap information has already been provided. |
| Where do Medigap claims go to? | Private insurance companies. |
| What is Remittance Advice? | Document detailing services billed & payment determination issued to providers. |
| Who runs the Medicare Part A program? | The Centers for Medicare and Medicaid Services. |
| Is Medicare a federal program? | Yes, Medicare is a federal program. |
| What does Medicare Part A cover? | Inpatient care, such as hospital stays, & hospice care. |
| What does Medicare Part B cover? | Outpatient care, such as doctor visits & diagnostic tests. |
| When does the benefit period for Medicare Part A end? | After discharge & 60 consecutive days have passed without any medical care. |
| What is the current annual deductible for for medicare Part B? | $104.90 |
| Are preventative care mammograms covered by Medicare? | Yes preventative care mammograms are covered by Medicare, for women 40 & over, once a year. |
| How often can Medicare be charged for pap-smears? | Once every 24 months if low risk, once every 12 months if high risk. |
| What does Medigap insurance cover? | Health care cost that are not covered by Medicare plans until deductible is met. |
| What is the name for supplemental plans covered by the employers? | MSP(Medicare Secondary Payer). |
| What does Senior HMO cover that Medicare does not? | Eyeglasses & prescription drugs. |
| What program contracts with CMS to review for medical necessity? | Quality Improvement Organization (QIO). |
| What percent does Medicare generally agree to pay? | Most commonly 80%. |
| What is the negotiated amount based on? | Total amount billed. |
| In the Medicare program, what is a mandatory assignment in benefits covered? | Surgery performed in the physician's office. |
| What is a Medicare prepayment screen? | Identifies claims to review for a medical necessity & monitor the number of times billed for such procedures during a specific time frame. |
| When a patient signs an ABN, what modifier is used? | HCPCS Level II modifier "GA" |
| What is a perspective payment system? | Hospitals treating Medicare patients are reimbursed according to pre-established rates of illnesses based on diagnosis. |
| What are payments to hospitals classified as? | D.R.G.s, diagnosis-related groups. |
| What is the Omnibus Reconciliation Act? | In the case of a current/former employee or dependent younger than 65, & eligible for Medicare solely because of ESRD, the employer's group coverage is primary for up to 30 months. |
| What level are alpha-numeric HCPCS codes? | Level 2. |
| What is a fiscal intermediary? | Organization under contract to the state to process claims for a Medicaid program, for hospitals, nursing facilities, home health agencies, long term care facilities, and intermediate facilities. |
| What do the letters after the medical ID numbers on the medicare card stand for? | The status of the individual. |
| What does the letter "D" stand for on Medicare Part D plan? | Widow status. |
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