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Insurance questions

Medicare questions

A federal violation occurs in Medicare if "Signature on File" is stated on the CMS-1500 form, but records do not include this. True
In a staff model HMO, providers are hired directly by the health plan that pays their salary? True
Medicaid is not so much an insurance program as an assistance program? True
A physician who is incorporated is considered an employee under worker's compensation laws? True
A paper claim is one that is submitted on paper, then optically scanned and converted to electronic form by the insurance company? True
In a point of service (POS) program, members may choose to use a nonprogram provider at an time? True
Medicaid is administered by federal funding only? False
Waiting periods affect worker's compensation medical and hospital benefits? False
List all services on the insurance claim form, including "No Charge" services? False
Managed Care Plans allow laboratory tests to be performed at any facility the patient chooses? False. Think CLIA Law.
A physician may accept or refuse MEDICAID patients on the basis of the individual patient and his/her circumstances? False
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
According to OCR guidelines, all information 0n the CMS 1500 claim form should be typed in UPPER CASE? True
Managed care plans NEVER require a CMS 1500 claim form to be completed and submitted? False
Family Planning is a MEDICAID basic benefit? True
Authorization to treat a patient with an industrial injury may be obtained over the telephone? True
A copayment in a managed care plan is usually a fixed dollar amount? True
If a service is totally disallowed by Medicaid, a physician is within legal rights to bill the patient? True
Disability Income Policies do not provide medical expense benefits? True
Medicare provides insurance for disabled workers of any age? True
Prior approval or authorization is never required in the MEDICAID Program? False
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
Each Medicare Hospital Benefit consists of 60 consecutive days in a hospital or nursing facility? False. Why?
When Medicaid and a third party payer covers the patient, Mediciad is always the payer of last resort? True
Funds for Medicare Part B, come equally from those who sign up for it and the federal government? True
Providers may choose to accept TRICARE assignment on a case-by-case basis? True. Similar to Medicare.
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.
TRICARE/CHAMPVA is usually the secondary payer when a beneficiary is enrolled in other health insurance plans? True
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.
Medicare transmits Medigap claims electronically for participating providers when Medigap information is provided on the original Medicare Claim? True. Cross-over claim
Medigap payments go directly to the beneficiary? False.
The health insurance claim form (CMS1500) is known as the? Universal claim form.
America's oldest privately owned prepaid medical group is the? Ross-Loos Medical Group (Now known as Cigna)
The Social Security Acr of 1935 did what? Set up the public assistance program.
The statutes for worker compensation laws fall under? Federal and State compensation laws.
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.
Medicaid is administered by the? State Government with partial federal funding.
What plan allows members of Kaiser Permanente Medical Care Program to seek medical help help form non-Kaiser physicians? Point of Service.
An abnormal condition caused by exposure to environmental factors associated with emploment is termed a/an? Occupational illness.
A significant contribution to HMO development was the? Health Maintenance Act of 1973
For Medicaid the time limit to appeal a claim varies from state to state, but is usually? 30-60 days.
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.
Premiums for worker's compensation insurance are payed by the? Employeer
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.
Tricare, formerly known as CHAMPUS, is funded through? Congress
The CMS-1500 claim form is divided into which of the following major sections? Patient and Physician Information.
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)
The simplest type of workers; compensation claim is? Nondisability (ND)
Practitioners in an HMO program ma come under peer review b a professional group called? Qualit Improvement Organization
The health maintenance organization (HMO) provided for dependents of active dut military personnel is called? TRICARE Prime
Referral of a patient recommended by one specialist to another specialist is known as? Tertiary Care
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
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.
CHAMPVA is a/an? Service Benefit Plan
The form that contains authorization for the physician to treat the injured employee is the? Medical Service Order
Medicare Part A is run by? The Center for Medicare and Medicaid Services (CMS)
Supplemental report(s) for patients on temporary disability should be sent to the insurance carrier how often? After every office visit.
Medicare Part A covers? Hospice Care
Medicare Part B covers? Diagnostic tests.
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
Medigap insurance may cover? The deductible not covered under Medicare.
A participating physician with the Medicare plan agrees to accept? 80% of the Medicare approved charge.
The time limit for submitting a Medicare claim is? The end of the calendar ear following the fiscal year in which sevices where performed.
NPI National Provider Indentifier
MCO Managed Care Organization
CMS Center for Medicare and Medicaid Services
SSDI Social Security Disability Insurance
SSI Supplemental Security Income
Last session, I promise. Word Bank Promise
Dependents of individuals who have died as a result of a service-connected injury qualify to receive (blank) benefits? CHAMPVA
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.
A primary care physician who controls patient access to specialists is called a/an? Gatekeeper
A claim that is submitted to the insurance carrier via a dial-up modem is referred to as a (blank)? Electronic
Medicare provides insurance for people (Blank) years of age or older who are retired on Social Security? 65
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
The two Medicaid eligibilty classifications are the (Blank) needy group and the (Blank) needy class? Categorically and Medically
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
The legal word (Blank) means to substitute one person for another? Subrogation.
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
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
Medicaid was legally established by Title (Blank) of the Social Security Act XIX
Done Done.
Created by: douelt