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Ashworth college

Lesson group 4 / medical billing and coding / medicare / Medicaid /tricare

QuestionAnswer
Which one of the following choices assigns a person to help coordinate and manage a patient's medical care? a) TRICARE Standard b) TRICARE Prime c) TRICARE Prime Remote d) TRICARE Extra B
Which one of the following choices processes all claims for TFL? a) CHAMPUS b) CMS c) TRICARE d) WPS I GOT THIS ONE WRONG! THE ANSWER IS NOT C)TRICARE
A TRICARE patient sees a chiropractor on a weekly basis for an injury. What might the patient be surprised to find out? b) The patient will probably be responsible for the entire bill.
A patient is in home health care for medically necessary reasons. How long will Medicare Part A cover home health care for the patient? a) 30 days b) 60 days c) 90 days d) As long as necessary D
On the "Medicaid Resubmission Code" form locator, what should be entered when filing a TRICARE claim? a) "X" b) "Y" or "N" c) The provider ID number d) Nothing I GOT THIS ONE WRONG! THE ANSWER IS NOT C)THE PROVIDER ID NUMBER
Review the completed TRICARE claim form (Figure 14.3) on page 423 of your textbook. What was the disease or illness code that brought the patient in for treatment? a) 99213 b) J11.1 c) 12345 d) 85.00 B
A Medicaid patient has a primary care physician whom she must go through if she needs to see a specialist. This patient is working under which Medicaid model? a) PCCM b) PHP c) RAC d) TEFRA A
A patient over age 65 was admitted to the hospital for a hip fracture and surgery. Which one of the following choices is probably the patient's primary hospital insurance? a) Medicare Part A
A patient has Medicaid plus another insurance. How should Medicaid be billed? a) As the primary insurer b) As the secondary insurer c) As the only insurer d) It depends on the other insurance. I GOT THIS ONE WRONG! THE ANSWER IS NOT ) AS THE PRIMARY INSURER
A physician doesn't participate in Medicare, but recently treated a Medicare patient. The doctor has decided to accept the Medicare-allowed charges for the services as payment in full. This is known as a) accepting assignment.
Which one of the following choices was implemented, in part, to help determine errors by FIs? a) CMS b) MMA c) RAC d) SNF I GOT THIS ONE WRONG! THE ANSWER IS NOT A)CMS
Which one of the following choices is the DOD medical entitlement program? a) TRICARE b) PCCM c) MTF d) DEERS A
A hospital doesn't have the blood type that it needs for a Medicare patient and has to buy it from a blood bank. What is probably the cost to the patient? b) The cost for first three units
Medicare was first created to a) provide older people health insurance. b) reduce healthcare costs. c) enable all people to have insurance coverage. d) allow people with disabilities to have free health care. A
To be eligible for TRICARE, families must be enrolled first in a) Medicaid. b) TFL. c) DEERS. d) CHAMPVA. C
What affect does the Affordable Care Act have on Medicaid? a) It increases the number of people eligible for Medicaid.
Which one of the following choices is a service that states can choose to offer under Medicaid? a) Prenatal care b) Vision coverage c) Vaccinations d) Blood tests B
A patient is covered under MediMedi. Which one of the following choices will be billed first? a) Medicare b) Medicaid c) MediMedi d) Patient I GOT THIS ONE WRONG! THE ANSWER IS NOT C)MEDIMEDI
Which one of the following choices is a responsibility of a MAC? I GOT THIS ONE WRONG! THE ANSWER IS NOT C) CREATING SNF DAY REQUIREMENTS FOR REIMBURSEMENT
A TRICARE patient needs to be treated at a civilian facility because of the specialized treatment provided there. What's the patient's first step? a) Receive a NAS.
A Medicare patient needs a hearing aid. Which one of the following choices will most likely cover the hearing aid? a) Medicare Part A b) Medicare Part B c) Medicare Part C d) Medicare Part D C
A physician just received information that tells her what payment she will receive for treating a Medicare patient and how much the patient owes. She is probably reviewing a(n) a) ERA. b) CMS-1500. c) MAC. d) MSP. A
Which one of the following choices was created as an incentive for physicians to participate in a voluntary quality reporting program? a) PACE b) PQRI c) TRHCA d) HCPCS B
A 24-year-old female Medicaid patient moved to a new state last week and saw the doctor for a checkup. After the treatment, the patient stops by the front desk to verify her Medicaid information. Which one of the following choices is mostaccurate? b) Medicaid verification should be made before treatment.
Which one of the following choices refers to when the federal government reimburses each state for a percentage of its medical service costs? d) Federal Medical Assistance Percentage
Which one of the following choices helps the CMS collect Medicare premiums? a) DRG b) SSA c) MA d) FI B
An active duty military member has TRICARE. Under the program, this person is called the a) insured. b) TPR. c) DEERS. d) sponsor. D
A Medicare Part A patient was in the hospital for 4 coinsurance days in 2017.How much will the patient have to pay total for those coinsurance days? a) $25 b) $289 c) $1,316 d) $4,624 C
A patient needs assistance for paying for her medications. Which one of the following choices might she use? a) Medicare Part A b) Medicare Part B c) Medicare Part C d) Medicare Part D D
Civil penalties, in addition to triple damages, can be imposed on providers who c) are found in violation for Medicare abuse or fraud.
An elderly Medicare patient has prescription drug coverage but isn't enrolled in Medicare Part D. She is probably covered under a) SSA. b) PACE. c) FFS. d) MAGI. B
Which one of the following benefits helps children and adolescents age 21 and under? a) FQHC b) PACE c) EPSDT d) ABN C
It's March 2018 and Dr. Smith still hasn't converted to an EHR. How much will Dr. Smith be penalized in the Medicare Part B reimbursement for not using an EHR? a) 1% b) 2% c) 3% d) 4% D
Which one of the following choices is used for permanent military personnel who aren't near any treatment facilities? a) TRS b) TFL c) TPR d) TYA C
How much would a patient pay for a standard Medicare Part B premium in 2017? a) $134 + 80% of the charges b) $134 + 20% of the charges c) $134 d) $0 C
A 65-year-old Medicare patient is also a retired colonel. After Medicare, which one of the following choices may be used for insurance coverage? a) TRS b) TFL c) TPR d) TYA B
A private health insurer that has been granted a specific geographic area to adjudicate Medicare Part A and Medicare Part B is known as a) RAC. b) LTR. c) MAC. d) SNF. C
A doctor wants to start seeing Medicaid patient and receive Medicaid reimbursement. What's important for the doctor to know? I GOT THIS ONE WRONG! THE ANSWER IS NOT A) MEDICAID DIAGNOSIS CODES ARE DIFFERENT THAN THOSE OF OTHER INSURERS
A patient has been denied the privately offered supplemental insurance that covers the things that Medicare doesn't cover. Which one of the following choices might be a reason the patient has been denied? d) The patient is enrolled in an HMO.
Which one of the following individuals is eligible for Medicare hospital insurance? c) 12-year-old girl receiving dialysis for end-stage renal disease
Created by: HoneyCocainee