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Lesson 17 & 18
Medicare and Tricare
| Question | Answer |
|---|---|
| 1. Under Medicaid, which one of the following choices could be categorized as "categorically needy"? | A. recipients of foster care assistance |
| 2. 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 |
| 3. A patient is in home healthcare for medically necessary reasons. How long will Medicare Part A cover home health care for the patient? | D. As long as necessary |
| 4. A 24-year-old female Medicaid patient moved to a new state last week and saw the doctor for a check up. After the treatment, the patient stops by the front desk to verify her Medicaid information. Which one of the following choices is most accurate? | B. Medicaid verification should be made before treatment |
| 5. Which one of the following choices provides sates grants to spend on cash assistance? | D. TANF |
| 6. To be eligible for TRICARE, families must be enrolled first in | C. DEERS |
| 7. A patient has a mole removed that posed no harm, but she didn't like the way it looked on her face. Coverage would probably be denied under Medicare because | D. It wasn't medically necessary |
| 8. 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. | A. accepting assignment |
| 9. A physician wants to start seeing TRICARE patients. What is it important they physician to remember? | C. Claims must be filed with 30 days from the time the patient is seen in the office |
| 10. 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? | C. $1, 316 |
| 11. A TRICARE patient needs to be treated at ta civilian facility because of the specialized treatment provided there. What's the patients first step? | A. Receive a NAS |
| 12. A 65-year-old Medicare patient is also retired colonel. After Medicare, which one of the following choices may be used for insurance coverage? | B. TFL |
| 13. Members of a small family want to know if they're eligible for TANF. Who will make the determination? | C. County government |
| 14. On the "Medicaid Resubmission Code" form locator, what should be entered when filing a TRICARE claim? | D. nothing |
| 15. Which one of the following choices is an example of Medicare fraud? | B. A physician makes no effort to collect coinsurance for Medicare patients |
| 16. A doctor wants to start seeing Medicaid patient and receive Medicaid reimbursement. What's important for the doctor to know? | C. Medicaid patients can't be billed for additional payment after Medicaid payment is received |
| 17. Which one of the following individuals is eligible for Medicare hospital insurance | C. 12-year-old girl receiving dialysis for end-stage renal disease |
| 18. A Medicare Part A patient has been hospitalized for 72 days. For how many of those days will the patient need to pay coinsurance? | B. 12 |
| 19. 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 |
| 20. Which one of the following choices was implemented, in part, to help determine errors by FIs? | C. RAC |
| 21. Which one of the following choices is covered for Medicare Part A inpatients? | B. semiprivate rooms |
| 22. 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 |
| 23. A bay was just born to a mother who is on Medicaid. The baby may be considered to fall under which one of the following categories? | B. categorically needy |
| 24. A patient needs assistance for paying for her medications which one of the following choices might she use? | D. Medicare Part D |
| 25. A patient has Medicaid plus another insurance. How should Medicaid be billed? | B. As the secondary insurer |
| 26. Which one of the following choices assigns a person to help coordinate and manage a patients Medicare care? | B. TRICARE Prime |
| 27. Which one of the following choices is a responsibility of a MAC? | B. Keep records on the quality of Medicare providers |
| 28. An active duty military member has TRICARE. Under the program, this person is called the | D. sponsor |
| 29. Which one of the following choices is used for permanent military personnel who aren't hear any treatment facilities? | C. TPR |
| 30. A hospital doesn't have the blood type that it needs for a Medicare patient and has to buy it from a blood blank. What is probably the cost to the patient? | B. the cost for the first three units |
| 31. You work in a physicians office and are reviewing detailed information on the coding and medical necessity of the services the physician provides. You are probably reviewing a(n) | D. LCD |
| 32. Medicare was first created to | A. provide older health insurance |
| 33. It's March 2018 and Dr. Smith still hasn't covered to and EHR. How much will Dr. Smith be penalized in the Medicare Part B reimbursement for not using an EHR? | D. 4% |
| 34. The decision of whether or not to reimburse Medicare payments to physicians who are noncompliant can be made by. | C. DHHS |
| 35. A physician performed a procedure on a Medicaid patient and the claim was given a final denial of "medically unnecessary". What will probably happen with the claim? | D. The physicians office will write off the claim and not be reimbursed |
| 36. 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? | B. J11.1 |
| 37. 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 |
| 38. Which one of the following choices is the DOD medical entitlement program? | A. TRICARE |
| 39. How much would a patient pay for a standard Medicare Part B premium in 2017? | C. $134 |
| 40. A Medicare patient needs a hearing aid. Which one of the following choices will most likely cove the hearing aid? | C. Medicare Part C |
| 41. Which one of the following choices processes all claims for TFL? | WRONG XXXX |
| 42. A Medicare patient wants to have his claims sent to his Medigap insurer. Through a notification on the claim. This reassignment is known as | A. Crossover |
| 43. Which one of the following benefits helps children and adolescents age 21 and under? | C. EPSDT |
| 44. Which one of the following choices helps to determine reimbursement for providers and also assesses the quality of healthcare provided by facilities? | WRONG NOT B |
| 45. Which one of the following choices is a service that states can chose to offer under Medicaid? | B. Vision coverage |
| 46. A patient has a spend-down level of $200 each month. What does this mean? | A. the patient must spend that amount each month before she's covered by Medicaid |
| 47. Which one of the following choices assists veterans who have service-related disabilities? | C. CHAMPVA |
| 48. An elderly Medicare patient has prescription drug coverage but isn't enrolled in Medicare Part D. She is probably covered under | B. PACE |
| 49. Which one of the following choices mainly helps uninsured children and pregnant women who cant qualify for Medicaid but don't have enough household income to pay for insurance coverage? | A. CHIP |
| 50. A patient is covered under MediMedi. Which one of the following choices will be billed first? | A. Medicare |
| 51. When filing a Medicaid claim, why would you leave the form locator for "Other Insured's Name" blank? | B. Because you need a verification number for the other insured |
| 52. A mother and child are both covered under the father's TRICARE. What should be entered on form locator 1a for the claim form? | B. The father's social security number |
| C. Are found in violation for Medicare abuse and fraud | |
| 54. A private health insurer that has been granted a specific geographic area to adjudicate Medicare Part A and Medicare Part B is known as | C. MAC |
| 55. 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 |
| 56. Which one of the following choices helps the CMS collect Medicare premiums? | B. SSA |
| 57. 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 patients primary hospital insurance? | B. Medicre Part B |
| 58. What affect does the Affordable Care Act have on Medicaid? | A. It increases the number of people eligible for Medicaid |
| 59. Review the completed claim form (Figure 14.3) on page 423 of your textbook. Who is the patient receiving coverage through? | A. TRICARE |
| 60. Which one of the following choices was created as an incentive for physicians to participate in a voluntary quality reporting program? | B. PQRI |
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Lulumac16